JP5372122B2 - Endoscopic treatment tool - Google Patents

Abstract

An insertion portion having a distal end and a proximal end, the distal end being inserted into a human body; a treatment portion provided at the distal end of the insertion portion; and a control portion provided at the proximal end of the insertion portion; wherein the treatment portion includes: a pair of forceps members; a tip cover which supports a pivot shaft that pivots at least one of the pair of forceps members openably and closably with respect to the other forceps member; a distal end holding portion that is fixed to the distal end of the insertion portion and in which the tip cover is held relatively movably toward the distal end of the insertion portion and toward the proximal end of the insertion portion; a distal end locking member that restrains a relative movement by locking the tip cover onto the distal end holding portion when the pair of forceps members is opened to grasp a specified object; and a distal end release member that is provided on an operational member by which the pair of forceps members is opened and closed and that releases an engagement made by the distal end locking member between the tip cover and the distal end holding portion at least when the pair of forceps members is closed.

Description

The present invention relates to an endoscope treatment tool .

As a method of performing medical practice on human organs, etc., laparoscopic surgery in which abdominal wall is incised to perform medical practice, laparoscopic surgery in which medical practice is performed by approaching the abdominal cavity through the opening formed in the abdominal wall, Endoscopic procedures for performing a desired treatment by inserting a flexible endoscope into the body from the anus or the like are performed.
In medical practice using these methods, treatments such as tissue suturing, binding, and ligation are performed. When performing such a treatment, an indwelling device that is often placed in the body is used. Such an indwelling device is attached to an applicator, and is operated at a desired site in the body by operating the applicator from within the body.
Patent Document 1 discloses an example of such an indwelling device and an applicator for placing the indwelling device (hereinafter, the indwelling device and the applicator are collectively referred to as a treatment device). The treatment tool disclosed in this related art is configured to move the hook sheath to the distal end side after puncturing the tissue with the detachable needle attached to the curved needle, and after engaging the detachable needle with the casing engaged with the distal end, Is pulled to the base end side, and the detachable needle is removed from the curved needle.

US Patent Application Publication No. 2003/0181924

In order to engage the detachable needle with the casing, it is necessary to advance and retract the hook sheath that holds the casing. For this purpose, it is necessary to change the operation portion. Further, in order for the detachable needle to engage with the casing, the detachable needle and the central axis in the longitudinal direction of the casing need to coincide with each other, and the surgeon had to check during the operation. The conventional operation unit has a complicated structure and requires skill for operation.
An object of the present invention is to provide an endoscopic treatment tool with improved operability.

In order to solve the above problems, the present invention proposes the following means.
The endoscope treatment tool according to the present invention includes a first sheath and a second sheath in which a treatment portion for performing treatment is connected to the distal end side, and an operation portion for operating the treatment portion is connected to the proximal end side. And a pair of first through holes are formed in parallel, and the first sheath and the second sheath are inserted into the pair of first through holes, respectively . A first holder that bundles two sheaths and a pair of second through holes are formed in parallel, and the first sheath and the second sheath are inserted into the pair of second through holes, respectively. in the first sheath and bundling the second sheath, the second holder provided on the front end side of the first holder, sliding the second sheath relative to the first holder A first adjusting member for providing dynamic resistance, and the first holder with respect to the second holder. The over scan, is characterized by including a second adjusting member for applying sliding resistance greater than the first adjustment member.

In the endoscopic treatment tool, a first wire for operating the treatment portion is inserted into the first sheath, and the second sheath is used for operating the treatment portion. More preferably, the second wire is inserted.

In the endoscope treatment tool, it is more preferable that the first wire is a forceps operation wire that opens and closes at least one of a pair of forceps members provided in the treatment portion with respect to the other.

In the endoscope treatment tool, the operation unit includes a forceps operation unit that opens and closes the forceps member, a hook operation unit that operates a hook that tightens a suture, the forceps operation unit, and the hook operation. It is more preferable to include an operation main body that is slidably arranged on the same axis.

Further, in the above-described endoscope treatment tool, the hook operation unit is disposed on a distal end side in the insertion direction with respect to the forceps operation unit, and the hook operation unit includes a plurality of hooks extending toward a proximal end side in the insertion direction. It is more preferable that a finger hook portion is provided, and the forceps operation portion can enter between the finger hook portions.

According to the endoscope treatment tool of the present invention, when the tip of the detachable needle is ready to engage with the casing, the engagement between the tip holding portion and the tip cover can be released. Since the detachable needle can be inserted into the casing in conjunction with the operation of closing the forceps member, the operability is improved .

It is a figure which shows schematic structure of the suturing device as one embodiment of an endoscope and the treatment tool for endoscopes. FIG. 2 is a diagram showing a configuration of an operation unit as viewed from an arrow A in FIG. 1. It is a partial cross section figure which shows the structure of an insertion part. It is the figure which looked at the valve body along the BB line of FIG. It is sectional drawing along CC line of FIG. It is an enlarged view of the front-end | tip part of a suturing device. It is a D arrow line view of FIG. It is E arrow line view of FIG. It is sectional drawing along the FF line of FIG. It is sectional drawing when a forceps member is opened. It is a G arrow line view of FIG. It is sectional drawing which shows the treatment tool containing a detachable needle, a casing, and a suture thread. It is sectional drawing along the HH line | wire of FIG. 12, and is the figure which latched the detachable needle. It is a figure which shows an example of the apparatus which cancels | releases latching of a detachable needle. It is sectional drawing along the II line | wire of FIG. It is a figure explaining a suturing method, Comprising: It is sectional drawing which opened the forceps member toward the opening. It is sectional drawing which closed the forceps member and pinched the structure | tissue containing opening. It is a figure which shows the one aspect | mode of the operation part which can perform twice puncture reliably. It is a figure which shows the other aspect of the operation part which can perform twice puncture reliably. It is sectional drawing along the JJ line of FIG. Along the KK line in FIG. It is the figure which pushed the stopper release button from the state of FIG. It is sectional drawing which pulled the front-end | tip cover and the forceps member and inserted the detachable needle into the casing. It is the figure which returned the front-end | tip cover and forceps member toward the front-end | tip, and removed the detachable needle accommodated in the casing from the curved needle. It is the figure which opened the forceps member after removing the detachable needle from the curved needle. It is a figure which indwells a treatment tool in the state which sutured the opening. It is sectional drawing which formed the front-end | tip nail | claw part integrally. It is the figure which comprised the front-end | tip holding | maintenance part, the bridge | bridging part, and the casing holding | maintenance part integrally. It is the figure which showed the front-end | tip part of the suture device of another form, and provided the notch in the receiving part. It is the figure which provided the notch and the taper surface in the receiving part. It is a figure which shows the modification of a 1st locking member. It is a figure which shows schematic structure of the suturing device as one embodiment of an endoscope and the treatment tool for endoscopes. It is sectional drawing of the area | region L of FIG. It is sectional drawing of the area | region M of FIG. FIG. 35 is a cross-sectional view taken along line NN in FIG. 34. It is sectional drawing which shows the structure of an insertion part. It is a schematic diagram which shows an endoscopic image. It is sectional drawing of the front-end | tip part of a suturing device. It is a partial cross section figure which shows the structure of an insertion part. It is a P arrow view of FIG. It is a Q arrow line view of FIG. It is the figure which opened a pair of forceps members. It is an enlarged view of a hook. FIG. 44 is a cross-sectional view taken along line RR in FIG. 43. It is sectional drawing which shows the structure of a cartridge. It is sectional drawing along the SS line | wire of FIG. It is the figure which looked at the casing from the insertion direction of a detachable needle. It is the figure which closed a pair of forceps members and grasped tissue. It is the figure which advanced the casing and accommodated the detachable needle. It is the figure which pulled back the casing and made the detachable needle detach from the curved needle. It is the figure which pushed out the casing after opening a pair of forceps members. It is the figure which attached the scope holder to the endoscope. It is the figure which looked at the scope holder from the half end side. It is a figure which shows the modification of a scope holder. It is a figure which shows the modification of a binding band. It is a figure which shows the scope holder using the binding band shown in FIG. It is a figure of the scope holder which provided the lock member integrally. It is sectional drawing which shows the other aspect of a valve body. (A) is sectional drawing of the side view which shows the modification of a cartridge, (b) is sectional drawing of the cartridge which shows the modification of (a). FIG. 60 is a cross-sectional view in plan view of the cartridge of FIG. 59 (a). It is sectional drawing which showed the modification of a hook and expanded the front-end | tip part of the suture tool. It is the figure which pulled the hook and pulled the suture. It is sectional drawing of the front-end | tip part of the suturing device by which a forceps member is driven by a separate link. It is a perspective view for demonstrating arrangement | positioning of a link. It is a figure which shows the process in which a pair of forceps members are rotated together in a closing direction. It is the figure where both a pair of forceps members rotated 90 degrees. The forceps member that has been completely closed is stopped, and the forceps member that has not been completely closed is rotated by 135 °. It is the figure which a pair of forceps member closed. It is the figure rotated in the direction which opens the closed forceps member. It is the figure rotated in the direction which opens a forceps member from FIG. It is the figure which made the forceps member differential. It is the figure which graphed the behavior of a pair of forceps members when changing the stroke of a rod. It is the figure which graphed the behavior of a pair of forceps members when changing the stroke of a rod. It is the figure which graphed the behavior of a pair of forceps members when changing the stroke of a rod. It is the figure which graphed the behavior of a pair of forceps members when changing the stroke of a rod. FIG. 73 is a diagram illustrating an operation corresponding to FIG. 72. FIG. 73 is a diagram illustrating an operation corresponding to FIG. 72. FIG. 73 is a diagram illustrating an operation corresponding to FIG. 72. FIG. 73 is a diagram illustrating an operation corresponding to FIG. 72. FIG. 73 is a diagram illustrating an operation corresponding to FIG. 72. FIG. 73 is a diagram illustrating an operation corresponding to FIG. 72. It is a top view which shows the external appearance of a mounting apparatus. FIG. 83 is a view on arrow T of FIG. 82. It is the figure which removed one base plate of the mounting part. It is a top view of a base plate. It is the perspective view which attached the cartridge to the holder. It is a perspective view of a thread holder. It is sectional drawing of a cartridge. It is a figure explaining operation | movement at the time of mounting | wearing a cartridge with a suturing device. It is the figure which engaged the suturing device with the mounting apparatus. It is an external view when a suturing device is engaged with a mounting device. It is the figure which pushed in the casing with the hook. It is the figure which returned the hook and pulled the needle holder via the suture thread. It is the figure which the holder pulled back by the coil spring. It is the figure which pulled the suture with the hook and pulled the holder. It is the figure which the casing removed from the holder. It is a figure which shows the other form of a mounting apparatus. It is the figure which removed one base plate of the mounting apparatus. It is a figure explaining the procedure which mounts a cartridge, Comprising: It is the figure which hooked the suture thread on the hook. It is the figure which pushed the button, retracted the rod, and applied tension to the suture thread. It is the figure which pulled the suture with the hook and pulled the rod. It is a figure which shows the example of an operation part. It is a figure which shows the modification of a mounting apparatus.

  Embodiments will be described in detail below with reference to the drawings. In the following embodiments, the same components are denoted by the same reference numerals. Moreover, the description which overlaps between embodiments is abbreviate | omitted.

(First embodiment)
FIG. 1 shows a suture instrument as an example of an endoscope treatment tool. In the suturing device 1 (applicator), a long insertion portion 3 extends from an operation portion 2 operated by an operator. The insertion portion 3 is inserted into the overtube 6 together with the endoscope insertion portion 5 of the endoscope 4. The distal end of the insertion portion 3 protrudes from the distal end of the overtube 6, and the treatment portion 7 is attached here.

  As shown in FIG. 2, the operation unit 2 includes an elongated operation body 10 having a shaft that is rigid and extends in the insertion direction. An insertion portion 3 extends from the distal end portion 10 </ b> A of the operation main body 10. A finger ring 11 is attached to the base end of the operation body 10. A slit 12 is provided on the distal end side of the ring 11 along the length direction of the operation main body 10, and a forceps operation unit 13 and a hook operation unit 14 are respectively provided in this order from the ring 11 side. It is slidably mounted independently in the 10 axial directions. Examples of the material of the operation unit 2 include ABS (acrylonitrile butadiene styrene) resin, polycarbonate, polyacetal, polyphenylsulfone, polyphthalamide, polyether ether ketone, and the like. If the operation part 2 is manufactured with ABS resin, polycarbonate, etc., it can be manufactured at low cost. When manufactured with polyacetal, the slidability is improved, so that the amount of force required for the operation can be reduced. In addition, when manufactured with polyphenylsulfone, polyphthalamide, or polyetheretherketone, it is excellent in chemical resistance and heat resistance, so there is little modification due to disinfection or sterilization.

  A forceps operation wire (forceps operation member, first wire) 15 is fixed to the forceps operation section 13. The forceps operation wire 15 is guided into the insertion portion 3 through the slit 12. In the hook operation unit 14, a pair of handles 16 extend from the side of the cylinder 14 </ b> A toward the base end, and a ring 17 (finger holding portion) for finger hooking is integrally formed at the base end portion of the handle 16. The distance between the pair of handles 16 is such that the forceps operation unit 13 is open so that the forceps operation unit 13 can enter. By pulling the ring 17 of the handle 16 beyond the forceps operation unit 13, the stroke of the hook operation unit 14 can be increased. Yes. A hook operation wire (hook operation member, second wire) 18 is fixed to the hook operation unit 14. The hook operation wire 18 is guided into the insertion portion 3 through the slit 12. The number of handles 16 may be one, or three or more.

  The operation main body 10, the forceps operation section 13, and the hook operation section 14 are made of a resin molded product, and are manufactured by fixing each integrally molded member with a snap fit. That is, the operation main body 10 is manufactured by bending an unfolded member and fixing with a snap fit. A ring 11 formed separately is fitted to the base end of the operation body 10. The forceps operation unit 13 and the hook operation unit 14 bend the members in the developed shape so as to cover the operation main body 10 and fix them by snap fitting.

As shown in FIG. 3, the insertion unit 3 includes a hook sheath 21 extending from the distal end of the operation unit 2 and a forceps sheath 22. A hook operation wire 18 is passed through the hook sheath 21 so as to freely advance and retract. A forceps operation wire 15 is passed through the forceps sheath 22 so as to freely advance and retract.
The insertion unit 3 is provided with an advance / retreat operation unit 25 (first holder) and a scope holder 26 (second holder) that form part of the operation unit 2 in the path. And the scope holder 26 bundle the two sheaths 21 and 22 in parallel. In the advance / retreat operation section 25, through holes 30 and 31 through which the two sheaths 21 and 22 are passed are formed in parallel. A first adjustment member 32 is inserted so that the tip protrudes into the through hole 30 of the hook sheath 21. In this embodiment, a screw is used for the first adjustment member 32. By sliding the first adjustment member 32 into contact with the hook sheath 21, the sliding resistance of the hook sheath 21 is increased. On the other hand, the forceps sheath 22 is fixed to the advance / retreat operation unit 25 in a state of being inserted into the through hole 31.

  The scope holder 26 has a holder body 35 in which through holes 33 and 34 through which the two sheaths 21 and 22 pass are formed in parallel, and a cylindrical shape through which the endoscope insertion portion 5 of the endoscope 4 passes from the holder body 35. The receiving portion 36 is integrally formed. A through hole 34 is formed in the scope holder 26. The forceps sheath 22 is inserted into the through-hole 34 so as to freely advance and retract. Further, the second adjustment member 37 is disposed so as to contact the forceps sheath 22. In this embodiment, a screw is used as the second adjustment member 37. The sliding resistance of the forceps sheath 22 is increased by tightening the second adjustment member 37 and bringing it into contact with the forceps sheath 22. On the other hand, such an adjustment member is not provided in the through-hole 33 of the hook sheath 21, and is disposed so as to freely advance and retract.

  When the sheaths 21 and 22 exposed between the scope holder 26 and the advance / retreat operation unit 25 are grasped or the advance / retreat operation unit 25 is advanced, the sheaths 21 and 22 advance with respect to the scope holder 26. Since the endoscope 4 held by the scope holder 26 does not move, the treatment section 7 attached to the distal ends of both the sheaths 21 and 22 can be advanced with respect to the endoscope 4.

On the other hand, when only the hook sheath 21 is to be advanced, the hook sheath 21 is grasped and advanced. At this time, the advance / retreat operation unit 25 does not move by the first adjustment member 32. This is because the sliding resistance of the hook sheath 21 in the advancing / retracting operation portion 25 is small and the sliding resistance of the forceps sheath 22 by the second adjustment member 37 in the scope holder 26 is large. Only the hook sheath 21 moves forward to slide relative to the portion 25.
As described above, the advance / retreat operation unit 25 and the scope holder 26 can selectively use the advancement of both the sheaths 21 and 22 and the advancement of only the hook sheath 21. In order to assist the operator's operation, the colors of the hook sheath 21 and the forceps sheath 22 are changed, the surface of one of the sheaths 21 and 22 is made uneven, or the outer diameters of the sheaths 21 and 22 are made different. Then, it becomes easier to confirm the sheath in operation.
The sliding resistance by the first and second adjusting members 32 and 37 can be adjusted by the tightening amount. As another form of the first and second adjusting members 32 and 37, an O-ring may be used, and the sliding resistance may be changed depending on the thickness of the O-ring.

The advancing / retreating operation unit 25 and the scope holder 26 are made of a resin molded product, and are manufactured by fixing the integrally molded members with a snap fit. That is, the advancing / retreating operation unit 25 and the scope holder 26 are inserted after the sheaths 21 and 22 are inserted into the grooves that form the through holes 30, 31, 33, and 34 of the unfolded member and the first adjustment members 32 and 37 are inserted. Then, the unfolded member is bent and fixed with a snap fit.
Further, the hook sheath 21 is inserted into the coil sheath 41. The forceps sheath 22 is inserted into the coil sheath 42. Two coil sheaths 41 and 42 extend from the scope holder 26. The coil sheaths 41 and 42 are formed of a flat coil in which a metal flat plate is closely wound. From this, compared with the case where a tube is used conventionally, reduction of parts cost and reduction of an assembly man-hour can be aimed at. The outer surfaces of the hook sheath 21 and the forceps sheath 22 are covered with a heat shrinkable tube made of a material such as low density polyethylene, high density polyethylene, fluorine resin such as FEP or PFA. Here, in the case of low density polyethylene, the sliding resistance with the coil sheaths 41 and 42 can be reduced, and it can be made at low cost. In the case of high density polyethylene, the sliding resistance can be further reduced. Furthermore, in the case of a fluororesin such as FEP and PFA, since it has low sliding resistance and excellent chemical resistance and heat resistance, it is less denatured by disinfection and sterilization. Both can be operated with small force by reducing sliding resistance.

  As shown in FIG. 1, in the middle of the insertion portion 3, the two coil sheaths 41 and 42 and the endoscope insertion portion 5 of the endoscope 4 are bundled and an airtight structure is formed between the overtube 6. A valve body 50 is provided. Examples of the material of the valve body 50 include silicone rubber, natural rubber, isopropylene rubber, and the like, and are fixed to the coil sheaths 41 and 42 using an adhesive or the like. As shown in FIGS. 4 and 5, the valve body 50 is provided with through holes 51 and 52 for the sheaths 41 and 42 and a through hole 53 for the endoscope 4 in parallel. The valve body 50 is formed with tapered surfaces 54 and 55 by obliquely cutting both end faces of a cylindrical member. Due to the tapered surfaces 54 and 55, the length in the insertion direction of the portion 52 </ b> A opposite to the through hole 52 is shortened. Further, a press-fit portion 56 having a substantially circular outer shape in a cross-sectional view is formed on the outer periphery of the valve body 50. A similar press-fit portion 57 is also formed on the inner peripheral side of the through hole 53 for the endoscope 4. The valve body 50 is not easily caught by the overtube 6 by providing the tapered surfaces 54 and 55. Furthermore, since the press-fit portion 56 is provided, it comes into contact with the overtube 6 at only one place in the insertion direction, so that a reduction in sliding resistance due to a decrease in the contact area is expected and insertion becomes easy. Similarly, the press-fit portion 57 reduces the contact area with the endoscope insertion portion 5, so that the insertion of the endoscope insertion portion 5 is facilitated. In addition, since the portion 55A is thick and has increased rigidity, deformation of the valve body 50 can be suppressed. In addition, the opening part of each through-hole 51-53 is taper-shaped so that an outer diameter may be expanded, and insertion of the coil sheaths 41 and 42 and the endoscope insertion part 5 is easy.

Next, the treatment unit 7 will be described.
Further, as shown in FIGS. 6 to 8, a receiving portion 60 is fixed to the distal end side of the insertion portion 3. As shown in FIG. 8, the receiving part 60 has a C-shaped base part 61 into which the endoscope insertion part 5 of the endoscope 4 can be inserted. By cutting out part of the base portion 61, the outer shape of the endoscope insertion portion 5 and the suture instrument 1 is reduced, and the overtube 6 can be reduced in diameter. Further, the contact area between the receiving portion 60 and the overtube 6 can be reduced. From these things, the insertion into the overtube 6 or the body cavity becomes easy. In order to ensure the connection strength between the base portion 61 and the endoscope 4, a soft member 62 is attached to the inside of the base portion 61. The flexible member 62 also functions to prevent the base portion 61 from damaging the endoscope 4.

  Further, as shown in FIGS. 6 and 7, a taper portion 63 is formed at the proximal end portion of the receiving portion 60 on the side where the coil sheaths 41 and 42 are drawn. The tapered portion 63 is configured to reduce the outer diameter of the receiving portion 60 toward the base end portion, and when the treatment portion 7 pulled out from the overtube 6 during the procedure is accommodated in the overtube 6 again, The taper portion 63 prevents the outer periphery of the base portion 61 from being caught.

As shown in FIG. 9, a cylindrical hole 71 </ b> A in which the distal end portion of the coil sheath 42 is fixed to the outer periphery is disposed in the receiving portion 60. In addition, a tip holding portion 71 is disposed in the hole 71B so as to freely advance and retract. The distal end holding portion 71 extends along the axis of the coil sheath 42, the forceps sheath 22 is fixed to the proximal end portion, and the forceps operation wire 15 is passed through the inside.
A hole 72 and a slit 73 are provided at the distal end portion of the distal end holding portion 71. The hole 72 and the slit 73 are formed on a straight line of the distal end holding portion 71, and the end portion of the slit 73 extends to the proximal end side from the hole 72. A pin 75 that is a first locking member (tip locking member) is inserted into the hole 72. A part of the pin 75 protrudes into the tip holding portion 71 in a state of entering the hole 72. The pin 75 is attached to the outer periphery of the tip holding portion 71 by a leaf spring 76 that is an urging member. The leaf spring 76 biases the pin 75 in the direction in which the pin 75 is received in the hole 72. On the other hand, an elongated release member 77 is inserted into the slit 73. The release member 77 is a second release member (forceps release member) fixed to the tip holding portion 71 by laser welding, an adhesive, or the like, and is the base end of an elongated plate-like member and the center of the tip holding portion 71 The axial direction is cut diagonally.

  A cylindrical portion 81 of the tip cover 80 is inserted into the tip holding portion 71 from the tip opening side. The tip cover 80 includes a cylinder part 81 having an outer diameter substantially equal to the inner diameter of the tip holding part 71, and a cover body 82 formed integrally with the tip of the cylinder part 81. A coil spring 83 is disposed outside the tube portion 81 and urges the cover body 82 away from the bridge portion 85 fixed to the tip opening of the tip holding portion 71. The bridge portion 85 extends in a direction perpendicular to the insertion direction, the tip end of the tip holding portion 71 is fixed to one end portion, and the base end portion of a casing support portion 86 described later is fixed to the other end portion.

  A plurality of slits 91, 92, 93 are formed in the cylindrical portion 81 along the length direction. The slit 91 is formed around the axis of the cylindrical portion 81 in accordance with the position where the hole 72 of the tip holding portion 71 is formed. The width of the slit 91 is such that the pin 75 cannot enter, but only the base end portion 91 </ b> A of the slit 91 is widened so that the tip of the pin 75 can enter. The slit 92 is formed around the axis line in accordance with the formation position of the slit 73 of the tip holding portion 71. The width of the slit 92 is such that the release member 77 can be inserted. The base end of the slit 92 extends to the base end side from the base end portion 91 </ b> A of the slit 91.

  As shown in FIG. 6, the slit 93 is formed at a position that avoids the other slits 91 and 92. A pin 95 fixed to the bridge portion 85 is inserted into the slit 93 and serves as a slide guide for the cylinder portion 81.

  As shown in FIG. 9, a rod 100 constituting an opening / closing mechanism is inserted into the cylinder portion 81 so as to freely advance and retract. A forceps operation wire 15 is fixed to the proximal end portion of the rod 100. A concave portion 101 extending in the radial direction is formed at a position near the proximal end of the rod 100, and a ball 102 as a second locking member (forceps locking member) is inserted therein. The ball 102 is urged radially outward by a coil spring 103. The ball 102 can enter the large diameter portion 92A provided at the proximal end portion of the slit 92 of the cylindrical portion 81, but cannot enter the distal end side of the large diameter portion 92A.

Further, a release member 105 as a first release member (tip release member) is attached at a position rotated 180 ° around the axis on the tip side from the position where the ball 102 is disposed. The release member 105 protrudes at a position that coincides with the ball 102 around the rotation axis. The base end portion of the release member 105 has a tapered surface so that the pin 75 can easily get on.
One end of each of the two link members 111 and 112 is rotatably attached to the tip of the rod 100 via a pin 110. The other end of the link member 111 is rotatably attached to one end 115 </ b> A of the forceps member 115 with a pin 113. The forceps member 115 has a bent portion 115C from the one end portion 115A to the other end portion 115B, and the bent portion 115C is pivotally supported on the tip cover 80 by a pin 116 (a pivot shaft). Yes. A curved needle 120 (mounting portion) is fixed to the other end portion 115 </ b> B of the forceps member 115. A detachable needle 121 is detachably attached to the tip of the curved needle 120. The detachable needle 121 is formed with a proximal end portion 123 that fits the curved needle 120 after passing through a constricted portion 122 whose diameter is reduced from a sharp tip. One end portion of the suture thread 125 is pulled into and fixed to the proximal end portion 123. The constricted portion 122 is formed when the concave portion formed in the detachable needle 121 is crimped from four directions and the suture thread 125 inserted therein is fixed. In such a configuration, the outer diameter of the detachable needle can be made smaller than in the conventional case where the suture is fixed to the detachable needle using a suture knot. The suture thread 125 is pulled out through the slit 120A of the curved needle 120.

On the other hand, the other end of the other link member 112 is rotatably connected to the proximal end side of the intermediate member 131A by a pin 130. The distal end side of the intermediate member 131A is rotatably supported on the distal end cover 80 by a pin 132. The forceps member 131 is pivotally supported by the distal end cover 80 and a pin 132 (a pivot shaft) on the proximal end side. The distal end portion 131B of the forceps member 131 has an annular shape having an opening 133, and is curved toward the distal end. A needle 134 to be inserted into the tissue is fixed to the most distal portion.
As shown in FIG. 10, when the pair of forceps members 115 and 131 are opened, the tip of the detachable needle 121 attached to the curved needle 120 and the tip of the needle 134 of the forceps member 131 are at the same position in the insertion direction. Placed in. Since the needles 121 and 134 are inserted into the tissue substantially simultaneously, the needles 121 and 134 are unlikely to be detached from the tissue and can be punctured with certainty. Further, the needles 121 and 134 can be inserted deeply into the tissue.

Here, as shown in FIG. 6, in the forceps member 131, a portion 131 </ b> C supported by the tip cover 80 with the pin 132 is disposed outside the tip cover 80. The tip cover 80 has a recess 80B, and a portion 131C of the forceps member 131 is supported by the pin 132 in the recess 80B. As shown in FIG. 7, since there is no large step at the boundary between the portion 131C of the forceps member 131 and the tip cover 80, insertion into the body cavity is facilitated, and operability is improved.
In addition, since the forceps member 131 is supported outside the tip cover 80, a space is provided in the tip cover 80 for installing a charging spring that biases the forceps member 131 so as to be surely closed. As shown in FIGS. 7 and 9, the charging spring 140 is coiled around the pin 132 with play, and when the pair of forceps members 115 and 131 are closed, the one end 140A is the base of the intermediate member 131A. Abuts the end. The other end 140 </ b> B of the charging spring 140 abuts on the portion 131 </ b> C of the forceps member 131. The charging spring 140 biases the distal end portion 131B of the forceps member 131 to be completely closed when the forceps members 115 and 131 are closed.

  Here, since the charging spring 140 is wound in a coil shape, the end portions 140A and 140B extend to different positions in the width direction. As shown in FIG. 11, the one end 140A is disposed on the outer side, and the other end 140B is disposed closer to the center. This figure shows a state in which the forceps members 115 and 131 are opened, and the charging spring 140 does not function. The other end portion 112A of the intermediate member 131A bulges outward in the width direction so that the one end portion 140A of the charging spring 140 can come into contact therewith. On the other hand, the inner side of the other end portion 112A of the intermediate member 131A is notched and has an irregular shape in the width direction. By configuring the other end portion 112A of the intermediate member 131A in this way, interference with the intermediate member 131A can be prevented when the casing 150 is advanced or retracted. Further, in the configuration that avoids the casing 150, sufficient rigidity can be obtained by forming a deformed structure.

  As shown in FIG. 6, the pair of forceps members 115 and 131 are respectively provided with protruding stoppers 151 and 152 that come into contact with the distal end surface 80A of the distal end cover 80 when the forceps members 115 and 131 are completely closed. Is provided. By bringing the stoppers 151 and 152 into contact with each other, when the forceps members 115 and 131 are closed, the forceps member 115 does not bend and the axis of the detachable needle 121 is difficult to shift.

Next, as shown in FIG. 9, a casing 150 into which the other end portion of the suture thread 125 is drawn and a casing support portion 86 that supports the casing 150 will be described.
As shown in FIGS. 12 and 13, the casing 150 forms a cartridge (also referred to as an indwelling device) 153 that is indwelled in the body together with the suture thread (thread-like member) 125 and the detachable needle (tip member) 121.
The casing 150 is configured by combining cylindrical members 161 and 162, and an accommodation hole 163 into which the detachable needle 121 can be inserted is formed. The distal end side of the accommodation hole 163 has a tapered surface 163A, and the axis of the accommodation hole 163 and the axis of the detachable needle 121 are easily aligned. Further, a wire spring 165 that is a needle locking member (tip member locking member) for preventing the removable needle 121 from coming off is inserted into the accommodation hole 163. The wire spring 165 has a configuration in which a bar is bent in a U shape and both end portions 166 are bent 90 degrees so as to be parallel to the same direction. The end 166 of the wire spring 165 is arranged so as to reduce the width of the accommodation hole 163. In the initial state, the end portion 166 of the wire spring 165 is housed in the groove 167 in which the width of the accommodation hole 163 is widened, and when the detachable needle 121 enters the accommodation hole 163, the end portions 166 can be pushed apart. it can. As shown in FIG. 13, when the detachable needle 121 is accommodated in the accommodation hole 163, the proximal end portion 123 of the detachable needle 121 is completely accommodated in the casing 150. It doesn't hurt the organization.

  Examples of the material of the casing 150 include polyphenylsulfone, polyphthalamide, polyetheretherketone, titanium alloy, pure titanium, and the like. When the casing 150 is manufactured from a material such as polyphenylsulfone, polyphthalamide, or polyetheretherketone, it is difficult to denature in vivo due to its excellent chemical resistance and acid resistance. Furthermore, since it has excellent weldability, it can be assembled using ultrasonic welding or laser welding. Pure titanium and titanium alloys are excellent in biocompatibility.

  When the detachable needle 121 is accommodated in the casing 150, the wire spring 165 sandwiches the constricted portion 122 of the detachable needle 121. Note that when the detachable needle 121 is pulled out of the casing 150, the wire spring 165 also slides together, and the end 166 enters the narrow portion 168 on the tip side (see FIG. 12). Since the end 166 cannot be opened here, the wire spring 165 serves as a stopper to prevent the removable needle 121 from falling off. When it is desired to remove the detachable needle 121 from the casing 150, as shown in FIG. 13, a release device is inserted into the release hole 170 opened in the side portion of the casing 150, and the wire spring 165 is moved to the proximal end side as shown by an arrow. Return it. The end portions 166 return to the grooves 167 and the end portions 166 can be pushed open. Therefore, if the detachable needle 121 is pulled while the position of the wire spring 165 is fixed, the wire spring 165 is pulled out of the casing 150.

  An example of the release device is a configuration in which a release pin 182 is provided on a forceps member 181 of the forceps 180 as shown in FIG. When the operator inserts the release pin 182 into the release hole 170 by the operation on the hand side, the detachable needle 121 can be pulled out from the casing 150 even during the procedure. The form of the release device is not limited to the illustrated one, and any shape can be used as long as it can be inserted into the release hole 170 and can move the wire spring 165 to the proximal side.

  As shown in FIGS. 12 and 15, the suture thread 125 drawn into the casing 150 is drawn into the accommodation hole 163 from the base end side in the middle of the accommodation hole 163 with respect to the region where the detachable needle 121 enters. The base end side of the accommodation hole 163 communicates with a large-diameter hole 190 that opens to the base end surface of the casing 150. A brake part (thread locking member) 191 is disposed in the hole 190. The brake portion 191 has a flat shape that is crushed after winding a metal plate 193 around the elastic member 192 through which the suture 125 is passed, and generates a predetermined sliding resistance with the suture 125. The casing 150 is provided with a slit 194 penetrating in the radial direction, and the brake portion 191 is loosely fitted into the slit 194. Further, since the step 195 formed by the hole 190 and the slit 194 serves as a stopper for the brake portion 191, even if the brake portion 191 is pulled in the length direction of the suture thread 125, the brake portion 191 does not jump out of the casing 150. Absent. The brake portion 191 makes it possible to generate a predetermined sliding resistance when the casing 150 moves between one end and the other end of the suture 125, and the movement of the casing 150 is suppressed.

  Here, the end portion of the suture thread 125 drawn from the base end surface of the casing 150 forms a loop 200 (hook engaging portion). A double tear knot 201 is used to form the loop 200. Since the double tearing knot 201 can reduce the knot, it can be easily inserted into the hook sheath 21 even when the inner diameter of the hook sheath 21 is small.

  As shown in FIG. 10, the casing 150 is accommodated in the casing support portion 86. A ball (third locking member, casing locking member) 205 inserted through the hole 203 of the casing support 86 is locked in each of the annular recesses 202 formed on the side of the casing 150. The ball 205 is biased so as to be locked to the casing 150 by a plate spring 206 which is a biasing member fixed to the casing support portion 86. Further, the ball 205 and the leaf spring 206 may be integrated by laser welding or an adhesive. The front end of the casing support portion 86 is inserted into a guide hole 210 that is a guide portion of the front end cover 80 so as to freely advance and retract. The guide hole 210 has an enlarged base end. As shown in FIG. 9, in the enlarged portion 210A, the ball 205 can be moved radially outward. The diameter of the guide hole 210 is narrower at the tip portion 210B than at the enlarged portion 210A, and the ball 205 cannot be moved radially outward.

  In the casing support portion 86, a tip claw portion 211 attached to the hook sheath 21 is fitted into the hole 190 of the casing 150. The tip claw portion 211 has a flange 211A that comes into contact with a step 86A formed on the inner periphery of the casing support portion 86 from the tip side and serves as a stopper, and a hook 212 is accommodated in the through hole. The hook 212 is fixed to the distal end portion of the hook operation wire 18 that is passed through the hook sheath 21 so as to be able to advance and retract. A loop 200 (see FIG. 12) on the other end side of the suture thread 125 is hooked on the hook 212. Conventionally, an inner tube is provided between the hook sheath 21 and the casing support portion 86. However, in this embodiment, the apparatus configuration is simplified by eliminating the inner tube. As a result, the cost of parts and the number of assembly steps can be reduced.

  Here, as shown in FIG. 7, a mark 220 is provided on the side portion of the distal end cover 80 of the treatment portion 7 as a restricting portion that positions the endoscope 4 in the insertion direction. When the distal end portion of the endoscope 4 is aligned with the mark 220, the hard portion at the distal end of the endoscope 4 and the hard portion of the treatment portion 7 can be overlapped in the insertion direction. Conventionally, since the distal end portion of the endoscope 4 is positioned on the receiving portion 60, the overall rigid length is the sum of the length of the treatment portion 7 and the length of the rigid portion of the endoscope 4. Therefore, the insertion into the overtube 6 and the insertion into the living body were poor. In this embodiment, since the length of the hard portion is shortened, the insertability is improved. In addition, since the endoscope 4 is disposed closer to the distal end, the distal end cover 80 and the like do not interfere with the visual field of the observation device of the endoscope 4 and the visual field can be secured. As a defining member instead of the mark 220, a plate member 221 that abuts against the distal end surface of the endoscope 4 may protrude from the distal end cover 80 as indicated by a broken line. Further, as shown in FIG. 8, the inclined surface 225 is formed by obliquely cutting the corner portion of the tip cover 80. By forming the inclined surface 225, the suturing device 1 is accommodated in the inner diameter of the overtube 6 indicated by an imaginary line, and the advance / retreat operation is facilitated.

  Next, the operation of this embodiment will be described. In the following, a case where an opening formed in the stomach wall is sutured will be described, but the target site is not limited to this, and may be a luminal organ such as the esophagus, duodenum, small intestine, large intestine, uterus, and bladder. . Further, the natural opening into which the endoscope 4 is inserted is not limited to the mouth, and may be a nose or an anus. Furthermore, it may be used for treatment of perforations due to hemostasis or ulcers, and laceration of mucosal defects.

The endoscope insertion portion 5 of the endoscope 4 is passed through the scope holder 26, the valve body 50, and the receiving portion 60 in order, and the distal end surface of the endoscope 4 is aligned with the mark 220. In order to firmly fix the endoscope 4 to the suture instrument 1, the distal end of the endoscope 4 and the receiving portion 60 may be fixed with a tape or the like. Next, the cartridge 153 is set at a desired position of the suturing device 1. With another endoscope, the overtube 6 is inserted from the patient's mouth to the vicinity of the cardia or into the stomach. Next, the suture instrument 1 fixed to the endoscope 4 is inserted into the stomach via the overtube 6.
In the stomach, the position of the opening of the tissue that is the target site is confirmed by the observation device of the endoscope 4. Since the distal end portion of the endoscope 4 is arranged on the distal end side of the suturing device as compared with the conventional type, the visual field is not easily obstructed by the suturing device 1, and the opening of the tissue and the detachable needle 121 are within the same visual field. Can be paid.

Next, the forceps members 115 and 131 are opened in the stomach prior to suturing. Specifically, the surgeon advances the forceps operation unit 13 of the operation unit 2. The forceps operation wire 15 advances and the link members 111 and 112 connected to the rod 100 rotate the forceps members 115 and 131 around the pins 106 and 132 to open them. As shown in FIG. 16, when the open forceps members 115 and 131 are brought close to the opening SO that is the target site, the forceps members 115 and 131 are closed by sandwiching the tissue around the opening SO with the forceps members 115 and 131. .
When the surgeon retracts the forceps operation section 13 of the operation section 2, the forceps operation wire 15 retracts and the link members 111 and 112 are drawn into the distal end cover 80, and the forceps members 115 and 131 are moved around the pins 106 and 132. Rotate to close. The needle 134 of the forceps member 131 is inserted into the tissue and presses the tissue toward the opening SO. On the other hand, the curved needle 120 of the forceps member 115 is inserted into the tissue on the opposite side of the forceps member 131 with the opening SO interposed therebetween, and passes through the tissue that has been handed over to the forceps member 131 across the opening SO. Projects to the casing 150 side. As a result, as shown in FIG. 17, the curved needle 120 and the suture thread 125 are passed through the opening SO.

  Here, when the opening SO is relatively large and the opening SO cannot be pinched by one stitch, one end of the opening SO is punctured first, and the bent needle 120 is opened approximately half and the removable needle 121 and the needle 134 are opened. A space may be created between the two, and the tissue at the other end of the opening SO may be taken into the space and punctured.

  At this time, if the tissue is hard, the detachable needle 121 is difficult to penetrate the tissue, and a large force is applied to the forceps operation portion 13 so that the forceps operation portion 13 cannot be stopped at a position where the detachable needle 121 penetrates the tissue. In some cases, the operation is performed as a series of operations up to the position where the detachable needle 121 is engaged with the casing 150. In this case, it becomes impossible to puncture twice and sew as described above. In order to execute the puncture twice as described above, the operation unit 2 may be configured as shown in FIG. In the operation portion 2, a hole 401 communicating with the slit 12 is provided at the base end portion of the operation main body 10, and a cam rod 402 extending from the tip of the ring 11 is inserted therein. At the tip of the hole 401, an abutting portion 403 is provided so as to reduce the opening diameter. A spiral cam groove 405 is formed in the inner peripheral portion of the hole 401. The cam groove 405 extends at least half a circumference (180 °) or more in the circumferential direction. A rod 406 that can pass through the abutting portion 403 further extends from the cam rod 402. The rod 406 enters the slit 12, and a stopper 407 is provided at the tip so as to be able to contact the forceps operation unit 13. Further, one pin 408 extends radially outward on the outer periphery of the cam rod 402. The pin 408 is inserted into the cam groove 405, and the ring 11 is engaged with the operation main body 10 via the pin 408.

  With this operation unit 2, the forceps operation unit 13 can be pulled until it comes into contact with the stopper 407. When the ring 11 is rotated 180 ° from the position shown in FIG. 18, the rotational movement of the pin 408 rotating together with the ring 11 is converted into the linear movement of the ring 11 by the cam groove 405, and the ring 11 moves backward. A stopper 407 provided integrally with the ring 11 moves backward by, for example, a movement amount X. When the stopper 407 is retracted, the forceps operation unit 13 can be further retracted by the movement amount X. If the position at this time is set to a position where the tip cover 80 moves until the detachable needle 121 engages with the casing 150, the position of the first stopper 407 is set to the first position of the second puncture. The puncture can be surely performed twice.

  Another embodiment is shown in FIG. As shown in FIG. 19, a failure rail 410 is provided on the inner surface of the slit 12 of the operation main body 10 with a predetermined length along the length direction so as to rise inside the slit 12. A forceps operation section 411 is slidably attached to the slit 12 so as to advance and retract. The forceps operation unit 411 is a slider that opens and closes the forceps members 115 and 131. As shown in FIG. 20, a hole 412 orthogonal to the sliding direction is provided inside, and a stopper member 413 is inserted into the hole 412. The stopper member 413 is urged toward the opening reduced in diameter by the hole 412 by a coil spring 414 that is an elastic member, and a tip portion of the stopper member 413 protrudes from the forceps operation portion 411 to become a stopper release button 415. Further, the stopper member 413 is provided with a notch 416 on the side. As shown in FIG. 21, the notch 416 is sufficiently larger than the obstacle rail 410, but the position of the notch 416 and the position of the obstacle rail 410 do not coincide with each other in the natural state. For this reason, the forceps operation part 411 can be retracted only until the stopper member 413 hits the obstacle rail 410. As shown in FIG. 22, when the stopper release button 415 is pushed in, the stopper member 413 moves by the amount that the coil spring 414 contracts, and the position of the notch 416 and the position of the obstacle rail 410 coincide. Since the obstacle rail 410 can be avoided by the notch 416, the forceps operation portion 411 can be further retracted toward the ring 11. In this way, the operator can control the amount of movement of the forceps operation unit 411 by pressing the stopper release button 415 at the tip of the stopper member 413, so that the second puncture can be ensured.

  When the curved needle 120 and the suture thread 125 are passed through the opening SO, the forceps member 131 is biased in the closing direction by the biasing force of the charging spring 140, and the needle 134 is firmly bitten into the tissue. Further, the stoppers 151 and 152 of the forceps members 115 and 131 abut against the distal end surface 80A of the distal end cover 80, so that the forceps members 115 and 131 are prevented from bending, and the axis of the detachable needle 121 and the axis of the casing 150 substantially coincide. To do.

  Here, when the forceps members 115 and 131 are completely closed or immediately before they are completely closed, the taper surface of the release member 105 of the rod 100 drawn into the cylindrical portion 81 of the tip cover 80 pushes up the pin 75. When the pin 75 is pushed up, the engagement between the cylinder part 81 and the tip holding part 71 is released. As a result, the tip cover 80 can be retracted with respect to the tip holding portion 71. Therefore, as shown in FIG. 23, when the forceps operation wire 15 is further retracted, the distal end cover 80 is retracted while compressing the coil spring 83, and the forceps connected to the distal end cover 80 by pins 116 and 132 and stoppers 151 and 152. The members 115 and 131 are retracted. At this time, the ball 102 of the cylindrical portion 81 passes over the release member 77 and enters the large diameter portion 92A, and the cylindrical portion 81 and the rod 100 are connected.

On the other hand, the casing 150 is held by the casing support portion 86 and does not move. In addition, when the tip cover 80 is retracted, the outer periphery of the ball 205 engaged with the casing 150 is covered with the small-diameter portion 210B of the guide hole 210, so that the ball 205 cannot move radially outward. As a result, the removable needle 121 attached to the tip of the curved needle 120 is inserted into the casing 150 with the casing 150 prevented from moving. In the accommodation hole 163, the detachable needle 121 is locked to the casing 150 by the wire spring 165.
When the forceps operation wire 15 is pulled, the forceps operation section 13 is advanced. The tip cover 80 starts to move to the original position by the restoring force of the coil spring 83 provided outside the cylinder portion 81. At this time, since the cylindrical portion 81 and the rod 100 are connected by the ball 102 that has entered the large-diameter portion 92A of the slit 92, the tip cover 80 and the rod 100 advance integrally. Accordingly, the forceps members 115 and 131 move forward without being opened, and the curved needle 120 attached to the forceps member 115 is translated so as to be separated from the casing 150.

  The detachable needle 121 is detached from the bending needle 120 by this parallel movement. As shown in FIG. 24, the detachable needle 121 stays in the casing 150 and the curved needle 120 moves away from the casing 150. At this time, since the forceps members 115 and 131 are not yet opened, the curved needle 120 and the casing 150 do not interfere with each other. Thereafter, the ball 102 moving forward together with the cylindrical portion 81 of the distal end cover 80 contacts the release member 77 and is pushed into the rod 100 by the tapered surface of the proximal end of the release member 77. As a result, the engagement between the rod 100 and the cylindrical portion 81 is released, and the rod 100 can be advanced relative to the tip cover 80. As a result, when the forceps operation section 13 is advanced, the forceps members 115 and 131 can be opened. As shown in FIG. 25, when the forceps members 115 and 131 are opened, the curved needle 120 is pulled out from the tissue. The suture 125 remains in a loop shape while penetrating the tissue.

  When the suture thread 125 is tightened, the hook sheath 21 is advanced. The hook sheath 21 pushes the tip claw portion 211, and the tip claw portion 211 pushes the casing 150 from the tip cover 80 toward the tissue. Since the tip cover 80 has been returned to its original position, there is a portion 210A in which the diameter of the guide hole 210 is increased around the ball 205, the leaf spring 206 is elastically deformed, and the ball 205 is detached from the recess 202, The engagement between the casing 150 and the casing support portion 86 is released. When the casing 150 is protruded from the casing support portion 86, the hook operation portion 14 is retracted and the hook 212 is retracted. As the suture 125 engaged with the hook 212 is pulled, the loop of the suture 125 penetrating the tissue is squeezed. Since the handle 16 of the hook operation unit 14 can be pulled beyond the forceps operation unit 13, the suture thread 125 can be pulled until the casing 150 contacts the tissue. As a result, the opening SO is stitched by the cartridge 153 as shown in FIG. The cartridge 153 opens the opening SO by releasing the engagement of the hook 212 or cutting the suture thread 125 extending from the casing 150 with a known thread cutting treatment tool passed through the working channel of the endoscope 4. It is left in the body in a sutured state.

  In this embodiment, the pin 75 serving as the first locking member is provided so that the engagement between the tip holding portion 71 and the tip cover 80 can be released in the process of retracting the forceps operation wire 15. The removable needle 121 can be inserted into the casing 150 in conjunction with the operation of pulling the wire 15 and closing the forceps members 115 and 131. The conventional operation unit has a complicated structure and requires skill. However, in this embodiment, the operation of the detachable needle 121 can be performed by a series of operations of the forceps operation unit 13, so that the operation is simple. become. That is, for example, in the case of the treatment instrument described in US2003-0181924A1, in order to engage the detachable needle with the casing, it is necessary to advance and retract the hook sheath that holds the casing, and for that purpose, it is necessary to change the operation unit. . Further, in order for the detachable needle to engage with the casing, the detachable needle and the central axis in the longitudinal direction of the casing need to coincide with each other, and the surgeon had to check during the operation. In contrast, in this embodiment, when the tip of the detachable needle 121 can be engaged with the casing 150, the engagement between the tip holding portion 71 and the tip cover 80 can be released. Since the detachable needle 121 can be inserted into the casing 150 in conjunction with the operation of closing the forceps members 115 and 131, the operability is improved.

  Further, in this embodiment, a suture instrument is disclosed as an example of a treatment instrument. However, the present invention is not limited to this, and the present invention can be applied to biopsy forceps or grasping forceps having different shapes of forceps members 115 and 131. . When applied to biopsy forceps, it is possible to perform a series of operations for grasping the tissue by the operation on the hand side and for tearing the tissue. Further, when applied to grasping forceps, an operation of grasping a tissue by an operation on the hand side and an operation of moving the tissue can be performed as a series of operations.

Before the forceps members 115 and 131 are opened by providing the ball 102 which is the second locking member, the link mechanism of the forceps members 115 and 131 and the distal end cover 80 are configured to advance integrally. The forceps members 115 and 131 can be prevented from being opened until they are completely detached from the casing 150. Since the curved needle 120 and the casing 150 do not interfere with each other, the opening / closing operation of the forceps members 115 and 131 is ensured. Furthermore, since the removal of the detachable needle 121 from the bending needle 120 and the opening operation of the forceps members 115 and 131 can be performed by a series of operations of the forceps operation unit 13, the operation is simplified.
Since the ball 205 that engages the casing 150 and the casing support 86 is provided as a third locking member and the engagement of the ball 205 is controlled by the guide hole 210 of the tip cover 80, the casing 150 is securely fixed. It is possible to easily engage the detachable needle 121 with the casing 150.

  Since the forceps members 115 and 131 are provided with the stoppers 151 and 152 that come into contact with the distal end surface 80A of the distal end cover 80, the axial displacement of the curved needle 120 can be prevented when the forceps members 115 and 131 are closed. If the axis of the curved needle 120 is shifted, it becomes difficult to insert the detachable needle 121 into the casing 150, or it is difficult to remove the detachable needle 121 from the curved needle 120. In this embodiment, such a problem is solved.

Since the advance / retreat operation unit 25 and the scope holder 26 are provided in the path of the insertion unit 3 and only the hook sheath 21 or both the sheaths 21 and 22 are advanced and retracted simultaneously, the operation is easier than the conventional operation unit configuration. become. It becomes easy to conceive the sheath that the operator advances and retreats, and it becomes easy to master the operation. Further, since the advance / retreat operation unit 25 is separated from the operation main body 10, it is easy to share the operation.
Since the operation unit 2 is integrally provided with an operation unit (forceps operation unit 13) for operating the forceps members 115 and 131 and an operation unit (hook operation unit 14) for operating the hook 212, the operation unit Can be made compact and easy to handle. Since the hook operation unit 14 is arranged on the distal end side and the forceps operation unit 13 can be inserted between the handles 16, the stroke of the hook operation unit 14 can be increased, and the suture 125 can be easily tightened.

Here, various modifications of the suturing device 1 are shown.
As shown in FIG. 27, the tip claw portion 301 has the tip portion of the hook sheath 21 fixed, and the hook operation wire 18 is drawn therein. Furthermore, it is also fixed to the casing support portion 86 (the tip portion is opened slightly outward in the radial direction so that the casing 150 can be received). A claw portion 302 is integrally formed at the distal end of the distal claw portion 301, and the base end portion of the casing 150 can be locked. The tip claw portion 301 is formed by integrally forming a tip claw portion 211 as shown in FIG. 9 and a step 86A of the casing support portion 86 that receives the tip claw portion 211, so that the manufacturing cost and the number of assembly steps can be reduced. I can plan.

  As shown in FIG. 28, a support member 310 in which a tip holding portion 71, a bridge portion 85, and a casing support portion 86 are integrally formed may be used. The support member 310 is bent in a crank shape as a whole, and the cost of parts and the cost of assembly can be reduced as compared with the case where the tip holding portion 71 and the casing support portion 86 are configured separately. In addition, as a manufacturing method, metal injection molding, turning center processing, molding, casting, and forging can be used.

  As shown in FIG. 29, a notch portion 322 may be provided in a portion of the receiving portion 320 that engages with the outer member 321 to which the distal end portion of the coil sheath 41 is fixed. The receiving portion 320 is used for fixing the distal end portion of the endoscope 4 to the suturing device 323. By the cutout portion 322, the receiving portion 320 holds the outer member 321 in a substantially C-shaped cross-sectional shape. The position of the notch 322 is a position in contact with or close to the inner surface of the overtube 6 when the endoscope 4 and the suture instrument 323 are combined and inserted into the overtube 6. By notching the receiving portion 320 at this position, the outer diameter of the endoscope 4 and the suture instrument 323 can be reduced, and insertion into the overtube 6 can be facilitated. The suturing device 323 has a configuration in which the distal claw portion 301 with which the casing 150 is engaged is advanced and retracted by the sheath 326. The tip claw portion 301 moves back and forth inside the tip cover 80 and the casing holding portion 325 integrated therewith.

As shown in FIG. 30, the holding portion 330 that holds the outer member 321 in the receiving portion 320 has a notch portion 322 so that the cross section is C-shaped, and a tapered surface 331 that opens toward the distal end side. It is provided. The tapered surface 331 has a curved surface shape with the axis CL of the coil sheath 42 as the central axis. When the distal end cover 80 is retracted by operating the hook sheath 21 and the forceps sheath 22, the base end portion of the casing holding portion 325 is not caught by the receiving portion 320, so that the advancement and retraction can be performed smoothly.
The first locking member may be changed to a substantially cylindrical pin 75A as shown in FIG. 31 instead of the spherical pin 75 shown in FIG. When the cylindrical pin 75A is used, the fitting length with the hole 72 is increased, and the first locking member is difficult to come off during operation. Since the force necessary for releasing the engagement of the first locking member is stabilized, the first locking member cannot be removed while the tissue is being punctured.

(Second Embodiment)
FIG. 32 is a view in which the suture instrument of the second embodiment is passed through the overtube together with the endoscope.
In a suturing device 501 (applicator) which is an endoscope treatment tool, a long insertion portion 3 extends from an operation portion 2 operated by an operator. In the operation unit 2, a forceps operation unit 13 and a hook operation unit 14 are slidably attached to an elongated operation body 10 independently of each other.

As shown in FIG. 33 which is a cross-sectional view enlarging the region L in FIG. 2, the hook operation wire 18 and the hook sheath 21, the forceps operation wire 15 and the forceps sheath 22 are inserted into the distal end of the operation body 10. .
A sheath fixing pipe 511 is fixed to the hook sheath 21 by brazing. A portion of the end portion of the sheath fixing pipe 511 is cut by a plane offset from the axis, and two cutouts 512 and 513 are formed along the axial direction so as to have a D shape in a sectional view. The portion 514 left between the notches 512 and 513 is inclined so that the proximal wall surface opens toward the distal end. The wall surface on the distal end side of the portion 514 is substantially perpendicular to the axis. The wall surface on the distal end side of the notch 513 is inclined toward the distal end and radially outward so as not to be caught when the sheath fixing pipe 511 is inserted. A hole 515 into which the sheath fixing pipe 511 can be inserted is formed at the distal end of the operation body 10. The hole 515 has a wall portion 516 against which the end of the sheath fixing pipe 511 is abutted, and the tip of the wall portion 516 is a substantially D-shaped hole 515A in a cross-sectional view. The outer shape of the hole 515A is substantially equal to the cross-sectional shape of the notched portion of the sheath fixing pipe 511. Further, an elastically deformable hook 517 is formed on the tip side of the hole 515A using the peripheral wall of the hole 515. Since the hook 517 protrudes so as to be engageable with the notch 513, the sheath fixing pipe 511 cannot be removed.

When the sheath fixing pipe 511 is inserted into the operation body 10 and the end portion is abutted against the wall portion 516, the notch 512 is accommodated in the substantially D-shaped hole 515A, and rotation around the axis is restricted. At the same time, the hook 517 is inserted into the notch 513. The hook 517 is hooked on the wall portion of the portion 514 of the sheath fixing pipe 511 when the sheath fixing pipe 511 is pulled, thereby preventing the hook sheath 21 from coming off. The sheath fixing pipe 511 protrudes from the distal end of the operation main body 10 by a predetermined length and has a function of preventing the hook sheath 21 from being broken.
The hook operation wire 18 passed through the hook sheath 21 so as to be able to advance and retreat is pulled out beyond the wall portion 516, passed through the O-ring 518, and then inserted into the hook operation portion 14.

  As shown in FIG. 34 and FIG. 35, the hook operation unit 14 has a pair of claws 519 extending beyond the path through which the hook operation wire 18 passes, and the hook operation wire 18 passes inside between the claws 519. Inserted. A wire fixing pipe 520 is caulked and fixed to the end of the hook operation wire 18. By locking the wire fixing pipe 520 to the hook operation unit 14, it is prevented from coming off. The wire fixing pipe 520 is disposed in a slit 521 formed from the outer peripheral side of the hook operation unit 14 toward the inside. The length of the slit 521 is substantially equal to the length of the wire fixing pipe 520, and the advance and retreat of the wire fixing pipe 520 is restricted by the wall portions 521A and 521B in the front-rear direction of the slit 521.

  Further, a locking band 523 is inserted into the slit 521. The locking band 523 is substantially U-shaped, and the open end side is open. The curved portion of the locking band 523 is in surface contact with the side surface on the center side of the hook operation portion 14 on the outer peripheral surface of the wire fixing pipe 520, extends from here to the outer periphery of the hook operation portion 14, and the end portion thereof is a wire. The fixing pipe 520 is fixed to the hook operation unit 14 on the outer side in the radial direction from the position where the fixing pipe 520 is passed. This prevents the wire fixing pipe 520 from moving inward in the radial direction.

  The outward movement of the wire fixing pipe 520 in the radial direction is restricted by the hook operation wire 18 being locked to the end of the slit of the claw 519. Since the hook operation wire 18 is fixed to the hook operation portion 14 in this way, the push-out resistance of the hook operation wire 18 increases and the hook operation wire 18 is not detached from the hook operation portion 14 even if it is deformed.

As shown in FIG. 33, a brass sheath fixing pipe 525 is fixed to the end of the forceps sheath 22 by caulking. The sheath fixing pipe 525 has a locking portion 525A formed by expanding the outer periphery on the tip side. When the locking portion 525A is inserted into the groove 526 formed on the operation body 10 side, the forceps sheath 22 can be locked to the operation body 10. The sheath fixing pipe 525 passes the forceps sheath 22 from the locking portion 525A side and crimps and fixes it from the proximal end side. Since the locking portion 525A is formed on the distal end side, it is easy to put a caulking tool. In addition, since the sheath fixing pipe 525 is made of brass, cutting is easier than in stainless steel, and the cost can be reduced.
As shown in FIG. 36, the hook sheath 21 and the forceps sheath 22 are passed through the advance / retreat operation section 25 and the scope holder 26 in order. The forceps sheath 22 is fixed to the advance / retreat operation unit 25. The hook sheath 21 increases the sliding resistance by an O-ring 530 housed in the advance / retreat operation unit 25. Two accommodating portions 531 of the O-ring 530 are formed in the length direction, and the O-ring 530 is accommodated in only one of them, but the O-ring 530 may be accommodated in both accommodating portions 531.

  Further, the forceps sheath 22 passed through the scope holder 26 has an increased sliding resistance by an O-ring 530 in the housing portion 532. Two accommodating portions 532 are formed in the length direction, and the O-ring 530 is accommodated in each of them, but may be accommodated only in one. In the forceps sheath 22, a pipe 533 is caulked and fixed to a portion accommodated in the advance / retreat operation unit 25. The pipe 533 is fitted in the groove of the advance / retreat operation unit 25.

Here, when the hook sheath 21 exposed between the advance / retreat operation unit 25 and the scope holder 26 is grasped and advanced / retracted, there is one O-ring 530 functioning as a brake for the hook sheath 21, whereas the brake for the forceps sheath 22 is provided. There are two O-rings 530 that function as a forceps, and the forceps sheath 22 has a higher sliding resistance. For this reason, only the hook sheath 21 moves, and the forceps sheath 22 does not move.
When it is desired to move the two sheaths 21 and 22 at the same time, the advance / retreat operation unit 25 is grasped and moved forward and backward. Since the forceps sheath 22 and the advance / retreat operation unit 25 are engaged with each other by the pipe 533, an advance / retreat force that overcomes the braking force of the two O-rings 530 in the scope holder 26 is applied. The hook sheath 21 moves together with the advance / retreat operation unit 25 by the sliding resistance of the O-ring 530 in the advance / retreat operation unit 25.

By using the O-ring 530 as a sliding resistance adjusting member in the advance / retreat operation unit 25, an appropriate brake can be realized at a low cost when the sheaths 21 and 22 are advanced and retracted. When using an O-ring having a small sliding resistance with the sheaths 21 and 22, three or more O-rings may be used. The durability of the O-ring can be improved while ensuring the brake performance. Further, instead of an O-ring, a resin tube such as silicone may be used.
Note that the wire diameter of the coil of the forceps sheath 22 is increased to increase the hardness so that the forceps sheath 22 is not bent and only the hook sheath 21 is not advanced when the advance / retreat operation unit 25 is advanced. A suitable hardness of the forceps sheath 22 in this case is set to such a degree that the forceps sheath 22 does not buckle when the suturing device 501 is pressed against the tissue.

  Further, the wire diameter of the coil of the hook sheath 21 is increased so that the hook sheath 21 is not bent when the scope holder 26 is grasped and the hook sheath 21 is pushed in. Thereby, the hook sheath 21 can be pushed in smoothly. Further, the clearance between the hook sheath 21 and the hook operation wire 18 is reduced so that the hook operation wire 18 slides on the hook sheath 21. If the clearance between the hook sheath 21 and the hook operation wire 18 is large, the hook operation wire 18 may bend and meander in the hook sheath 21. In this case, it is necessary to increase the operation stroke of the hook operation unit 14 by the amount that the hook operation wire 18 meanders. On the other hand, since the suture instrument 501 has a reduced clearance, the stroke amount is reduced, and the operability of the hook operation wire 18 is improved.

  Here, the forceps sheath 22 and the hook sheath 21 are inserted into the scope holder 26 in a predetermined order. When holding the endoscope 4 with the left hand and operating the hook sheath 21 and the forceps sheath 22 with the right hand, the hook sheath 21 is disposed on the right side of the operator and the forceps sheath 22 is disposed on the left side of the operator. As a result, in the image 535 of the endoscope 4 shown in FIG. 37, the hook on the right side and the curved needle 120 on the left side are arranged. Since the left and right sides of the surgeon coincide with the left and right sides of the screen, the surgeon can easily operate.

  As shown in FIG. 36, the hook sheath 21 and the forceps sheath 22 are inserted into the coil sheath 41 and the coil sheath 42 in the scope holder 26, respectively. These coil sheaths 41 and 42 are formed of a coil in which flat plates are closely wound. Locking members 340 and 341 are fitted into the scope holder 26 to prevent the coil sheaths 41 and 42 from coming off. The locking members 540 and 541 are fitted into a recess provided on the scope holder 26 side, and two protrusions 542 are provided apart from each other in the length direction of the coil sheaths 41 and 42. In the two locking members 540 and 541 arranged with the coil sheath 41 interposed therebetween, the protrusions 542 are alternately arranged in the length direction. Similarly, in the two locking members 540 and 541 disposed with the coil sheath 42 interposed therebetween, the protrusions 542 are alternately disposed in the length direction. Since each protrusion 542 enters between the coil wires, the coil sheaths 41 and 42 are prevented from coming off. When the coil sheaths 41 and 42 are fixed, the locking members 540 and 541 are fitted into the scope holder 26, and the hook sheath 21 and the forceps sheath 22 are passed through the through groove of the scope holder 26, and the The amount of protrusion of the coil sheaths 41 and 42 is adjusted. After positioning, the coil sheaths 41 and 42 are pushed into engagement with the protrusions 542. If it does in this way, while being able to shorten assembly time, the length adjustment of the coil sheaths 41 and 42 becomes easy.

  The outer periphery of the hook sheath 21 is not covered, and has a double structure of the hook sheath 21 and the coil sheath 41. These sheaths 21 and 41 are manufactured from stainless steel, and since there is no coating, the slip between the sheaths 21 and 41 becomes good. Even when the endoscope 4 is bent at an angle, the hook sheath 21 can be easily advanced and retracted.

  As shown in FIG. 38, the wire diameter of the hook sheath 21 is different between the coil 21A on the hand side and the coil 21B on the tip side. By making the wire diameter of the coil 21 </ b> A on the near side thicker, the coil does not extend when the hook sheath 21 is pulled. Further, by reducing the wire diameter of the coil 21B on the distal end side, the flexibility is improved, so that the endoscope 4 can be easily angled. Furthermore, the hook sheath 21 can be slid with a light force in an angled state. As shown in FIG. 38, the proximal side of the coil sheath 41 is a flat coil 41A with a large plate thickness, and the distal end side is a flat coil 41B with a thin plate thickness. When the forceps sheath 22 is advanced, the coil sheath 41 becomes difficult to extend, the operability of the forceps sheath 22 is improved, and the angle of the endoscope 4 can be easily applied at the distal end side. If the flat coil 41A having a large plate thickness is used up to the tip without using the flat coil 41B, the coil sheath can be made more difficult to extend. In addition, the boundary of each coil 21A, 21B, 41A, 41B is performed by welding.

  The outer periphery of the forceps sheath 22 is not covered, and has a double structure of the forceps sheath 22 and the coil sheath 42. By manufacturing these sheaths 22 and 42 from stainless steel, the slip between the sheaths 22 and 42 is improved. As shown in FIG. 38, the wire diameter of the coil 22A on the hand side of the forceps sheath 22 is increased so that the coil does not extend when the forceps sheath 22 is pulled. In addition, the wire diameter of the coil 22B on the distal end side is narrowed to make it easy to apply an angle to the endoscope 4. Furthermore, the forceps sheath 22 can be slid with a light force in an angled state.

  Here, the clearance between the coil sheath 41 and the hook sheath 21 is made small so that the gas fed into the body does not leak out of the body through the sheaths 21 and 41. The clear run between the coil sheath 42 and the forceps sheath 22 is similarly reduced. The airtightness is improved. For example, when the stomach is inflated, it becomes difficult for air to leak, and the air can be inflated in a short time. The swollen stomach will not deflate immediately. The number and time of air supply are reduced, the treatment becomes easy, and the stress on the operator can be reduced.

  As shown in FIGS. 32, 38, 40, and 41, the tips of the coil sheaths 41 and 42 are welded to the scope receiver 550. In the scope receiver 550, two cylindrical portions 551 and 552 connected to the coil sheaths 41 and 42 one by one and a cylindrical portion 552 that receives the endoscope 4 are integrated by a connecting portion 554 on the distal end side. The parts 551 to 553 are arranged substantially in parallel. Since the three cylindrical portions 551 to 553 are integrated, the parallelism of the two cylindrical portions 551 and 552 is increased, and the treatment portion 7 is easily projected and retracted.

  As shown in FIG. 40, the resin hood 55 is attached to the inner ring 556, and the inner ring 556 and the cylindrical portion 553 are integrated by welding. Therefore, processing of each member becomes easy. The inner diameter of the inner ring 556 is substantially equal to the inner diameter of the hood 555, and the base end surface 556A is chamfered so as to increase the inner diameter. The outer diameter of the inner ring 556 is larger than the inner diameter of the hood 555, and the groove 556B is formed in an annular shape. The hood 555 having a size that does not naturally come off the inner ring 556 within a range in which the endoscope 4 can be held is used. Mounting of the hood 555 during assembly is facilitated, and the number of assembly steps can be reduced. When attaching the hood 555, the inner ring 556 is fitted, and the tip of the hood 555 is fitted into the groove 354B. Next, the front end surface of the inner ring 556 and the cylindrical portion 553 are integrated by laser welding or the like. By sufficiently securing the depth of the groove 556B of the inner ring 556 and the fitting height of the hood 555, the mounting strength of the hood 555 is improved.

  As shown in FIG. 41, the opening 552A at the tip of the cylindrical portion 552 is cut into an arc shape centered on the rotation axis C1 of the scope receiving portion 550, and is substantially C-shaped. The outer shape of the scope receiver 550 is reduced, and it is easy to insert the scope receiver 550 into the overtube 6. Retraction is facilitated even when the treatment section 7 is tilted.

  As shown in FIGS. 38 and 40, the treatment section 7 has a distal end cover 560 supported by the scope receiving section 550, and a pair of forceps members 115 and 131 are supported by the distal end cover 560 so as to be freely opened and closed. Furthermore, a casing 150 that receives the detachable needle 561 attached to the forceps member 115 is housed in the tip cover 560 in a projecting manner. The length of the distal end cover 560 is adjusted so that the needle tip is surely settled on the screen of the endoscope 4 from when the forceps members 115 and 131 are opened to when the detachable needle 561 is received. Thus, for example, as shown in FIG. 37, in the image 535 of the endoscope 4, the pair of opened forceps members 115 and 131 and the detachable needle 561 are displayed at the bottom of the screen. With this arrangement, the locus of the detachable needle 561 can be confirmed on the image 535 until the pair of forceps members 115 and 131 are closed. Since the surgeon can perform the treatment while constantly checking the detachable needle 561, the reliability of the treatment can be improved.

  As shown in FIGS. 38, 40, and 42, the tip cover 560 includes a forceps receiving portion 571 to which the forceps sheath 22 is welded by a laser or the like, and a casing support portion 572 to which the hook sheath 21 is welded by a laser or the like. , And an integrated configuration connected by a connecting portion 573. In the forceps receiving portion 571, a link mechanism 576 configured to include a rod 575 connected to the forceps operation wire 15 is provided. A pair of link members 111 and 112 are connected to the tip of the rod 575 by a pin 110. The link member 111 is connected to the first forceps member 115 by a pin 113. The first forceps member 115 extends from one end connected to the pin to the other end to which the curved needle 120 is fixed, and is supported on the tip cover 560 by the pin 116 in the middle of the first forceps member 115. A detachable needle 561 is attached to the tip of the curved needle 120.

The other end portion of the other link member 112 is rotatably connected to the proximal end side of the intermediate member 131A by a pin 130. The distal end side of the intermediate member 131A is rotatably supported by the distal end cover 560 with a pin 132.
In the forceps member 131, a portion 131 </ b> C supported by the tip cover 560 with the pin 132 is disposed inside the tip cover 560. The forceps member 131 is biased so as to completely close the distal end portion 131B of the forceps member 131 when the forceps members 115 and 131 are closed by the charging spring 577. The charging spring 577 is wound around the pin 132 so as to be slidable. The end portion 577A of the charging spring 577 contacts the other end portion 112A (see FIG. 40) of the link member 112 when the pair of forceps members 115 and 131 are closed. The other end of the charging spring 577 contacts the portion 131C of the forceps member 131. The charging spring 577 is wound so as to be able to rotate while sliding on the pin 132, and hardly tilts with respect to the pin 132, so that it does not come off the link member 112 or the forceps member 131.

  As shown in FIG. 42, when the forceps members 115 and 131 are opened, the end portion 577A of the charging spring 577 protrudes from the tip cover 560 toward the tissue. The other end portion 577A is bent in a substantially U shape and is curved toward the distal end, so that even if the treatment portion 7 is pressed against the tissue, it does not pierce the tissue.

  In the state shown in FIG. 41, since the link members 111 and 112 are longer than the distance from the rod 575 to the pins 116 and 132, the rod 575 cannot move to the tip from this position. For this reason, it is not necessary to provide a pin in the rod and provide a guide hole in the tip cover as in the first embodiment. In addition, when using for positioning of the mounting apparatus described in another embodiment, a guide hole may be provided only on one side of the tip cover 560.

Here, the curved needle 120 is inserted into a hole 115D having a circular cross section formed in the first forceps member 115 and fixed by welding. The cross-sectional shape of the curved needle 120 is also substantially circular, and positioning of both is performed by a jig (not shown). As in the prior art, the number of processing steps can be reduced as compared with the case where the section of the fixed portion of the curved needle 120 is cut into a D shape.
A hook 581 is fixed to the tip of the hook operation wire 18. The hook 581 is accommodated in the hook sheath 21 in the retracted state. At this time, if the sliding resistance between the hook 581 and the hook sheath 21 is large, the movement of the hook 581 becomes worse. Furthermore, when the endoscope 4 is bent, the movement of the hook 581 becomes heavy. Therefore, the clearance between the hook 581 and the hook sheath 21 is increased so that the hook 581 can be advanced and retracted with a small force. The clearance is desirably greater than 0 mm and not greater than 0.1 mm. Within this range, the operation of the hook 581 is good, and the suture thread 125 is not detached from the hook 581.

  As shown in FIGS. 43 and 44, the hook 581 has an engaging portion 582 in which the width of the tip portion is reduced. The engaging portion 582 is large enough to allow the suture 125 to pass between the hook sheath 21 and the suture 125 can be hooked by a barb 582A toward the proximal end. When the engaging portion 582 is manufactured, cutting is performed by an end mill using a tapered blade. At this time, the end mill is cut obliquely from the proximal end side using a portion whose outer diameter is substantially equal to the suture thread 125. An overhanging jaw 584 is formed at the base end of the groove 583 formed thereby. The jaw 584 is disposed at the position offset from the axis of the hook 581 and on the same side as the barb 582A of the engaging portion 582 in the circumferential direction. When the hook 581 is pushed out from the coil sheath 41, the suture thread 125 is hooked on the jaw 584. Therefore, the suture thread 125 can be hardly pulled out in the process of moving the hook 581 back and forth. Even when the coil sheath 41 is bent, the jaw 584 prevents the suture thread 125 from falling off. When manufacturing the hook 581, when the groove 583 through which the suture thread 125 is passed is formed with an end mill using a blade having a large cutter taper, the enlarged diameter portion of the end mill is pressed against the periphery of the groove 583. A chamfer 585 is formed to reduce the width of the hook 581. Since the processing of the groove 583 and the chamfer 585 can be performed at a time, the manufacturing cost when the hook 581 is manufactured can be reduced.

  Such a hook 581 is manufactured by cutting a material having good cutting properties, such as SUS420F2. Thereby, the processing time can be shortened and the durability of the processing blade can be improved.

  As shown in FIG. 38, the hook sheath 21 is welded by a laser or the like to a support member 591 accommodated in the casing support portion 372 of the tip cover 560. The support member 591 is provided with a protrusion that holds the casing 150 at the tip, and a through-hole through which the hook 581 passes is formed. Further, a pair of arms 592 that engage with the casing 150 are welded. The arm 592 is manufactured from an elastic member having an elongated shape, and is bent so that the distal end side opens radially outward from a root portion welded to the support member 591. The tip of the arm 592 is bent inward. If the arm 592 is bent after welding, assembly time can be reduced. Since the arm 592 is welded to the concave portion of the support member 591, the outer diameter of the support member 591 of the portion to which the arm 592 is welded is substantially equal to the other portion and can smoothly advance and retract with respect to the casing support portion 572. .

  The casing support portion 572 has a proximal end reduced in diameter so as to be able to come into contact with the support member 591, has an inner diameter substantially equal to the outer diameter of the support member 591, extends in the axial direction, and then further increases in diameter And open at the tip. In addition, since the spacer 601 is inserted in the front end side of an inner hole, the part to which the internal diameter was expanded is only a part. In the portion where the inner diameter is expanded, the pair of arms 592 of the support member 591 are restored and opened by elastic force, and the engagement with the concave portion 202 of the casing 150 is released. In the portion where the spacer 601 is inserted, the arm 592 is closed and engages with the recess 202 of the casing 150. The portion where the spacer 601 is inserted corresponds to a position when the curved needle 120 is pulled out from the casing 150 after the pair of forceps members 115 and 131 are closed. Therefore, when the curved needle 120 is pulled out, the arm 592 is pressed by the spacer 601 to be elastically deformed and engaged with the casing 150, thereby preventing the arm from falling off from the casing support portion 572.

  Here, when the casing 150 is mounted, since the support member 591 is on the proximal end side, the pair of arms 592 are open so as to receive the casing 150. Therefore, the hook 581 is hooked on the loop 125 </ b> A and the hook 581 is pulled in, so that the attachment to the tip cover 560 is completed. Time and effort when mounting the casing 150 is reduced.

  As shown in FIG. 45, the cartridge (or also referred to as an indwelling device) 153 includes an attaching / detaching needle 561, a suture thread 125 fixed by caulking to the attaching / detaching needle 561, and a casing 150 through which the suture thread 125 is passed. The detachable needle 561 has a sharp end at the tip, and a slit 610 that can be fitted into the curved needle 120 is formed at the base end. The slot 610 is dimensioned so that the detachable needle 561 can be held and detached with an appropriate amount of force even when there is a dimensional error in the inner diameter of the curved needle 120. For example, when the total length of the detachable needle 561 is about 5 mm and the length of the slit 610 is about 1.4 mm, the spring constant decreases, and variation in the amount of detachment force between the detachable needle 561 and the curved needle 120 can be suppressed. The attaching / detaching needle 561 is provided with an abutting portion 611 that abuts against the distal end surface of the curved needle 120, but the slot 610 stops at the proximal end side from the position where the abutting portion 611 is formed. By not providing the slit 610 in a part of the portion inserted into the curved needle 120, the wobbling of the detachable needle 561 can be prevented, and the axis of the curved needle 120 and the axis of the detachable needle 561 can be easily matched.

  As shown in FIGS. 45 and 46, the base end of the detachable needle 561 is cut by a plane orthogonal to the slit forming the slit 610, thereby shortening the length in this direction. The distance between the cut end faces 612 is a size that can be inserted by bending the slit 610 even when the hole of the curved needle 120 has a minimum diameter including a design value tolerance. The length in the direction in which the width can be reduced by the slit 610 is longer than the distance between the end faces 612, but this direction can be elastically deformed according to the hole diameter of the curved needle 120 by the slit 610. By partially cutting the end of the detachable needle 121, a dimensional error of the curved needle 120 is allowed, and the detachable needle 561 can be securely attached to the curved needle 120 by light press fitting.

  As shown in FIG. 45, the suture thread 125 is passed through the casing 150, one end is fixed to the detachable needle 561, and the other end forms a loop 125A by double tearing knots. Yes. The length of the suture thread 125 from the detachable needle 561 to the casing 150 is about 35 mm, which is necessary and sufficient for binding the tissue. Moreover, the length of the part pulled out from the casing 150 is about 10 mm until it reaches the end of the loop 125A. Thus, the stroke amount of the hook 581 can be reduced from the position where the hook 581 is projected when the cartridge 153 is mounted to the binding position. By optimizing the length of the suture thread 125, the stroke amount of the hook operation unit 14 on the hand side can be reduced, and the operation becomes easy. By shortening the length of the portion pulled out from the casing 150, the suture thread 125 is not easily crushed when the casing 150 is pushed out, and is not caught in the hook sheath 21.

  Further, the length of the end portion 125B of the suture thread 125 remaining after forming the loop 125A is set to 2 mm or more. Accordingly, when the casing 150 is released, the end portion 125B of the suture thread 125 is not caught or rubbed against the inner surface of the hook sheath 21. The casing 150 can be smoothly advanced and retracted.

  As shown in FIGS. 38 and 45, the casing 150 has a two-piece structure. The proximal-side member 621 can be engaged with the support member 591 and a wire spring 165 is accommodated therein. The front end member 622 is formed with a through hole 623 that can accommodate the proximal end portion of the detachable needle 561. The wire spring 165 has a substantially U shape in a plan view, and both end portions 165A are bent substantially perpendicular to the insertion direction of the detachable needle 561. The distance between the pair of bent end portions 165A is substantially equal to the outer diameter of the reduced diameter portion 561A in which the attaching / detaching needle 561 is crimped, and is smaller than the outer diameter of the contact portion 611 on the proximal end side of the attaching / detaching needle 561. As shown in FIGS. 45 and 47, the member 622 on the distal end side is formed with a hole 624 into which the wire spring 165 can be inserted together with the through hole 623. The hole 624 has a flat shape into which a substantially U-shaped portion of the wire spring 165 can be inserted. When inserting the wire spring 165, the pair of end portions 165 </ b> A are deformed so as to be close to the outer diameter of the through-hole 623 or less and inserted from the holes 623 and 624. Between the distal end side member 622 and the proximal end side member 621, there is a space 625 where the end portion 165A can be expanded. When the wire spring 165 is inserted into the space 625, the end portion 165A is opened. 165 cannot be removed. When the detachable needle 561 is inserted, the end 165A is pushed and spread at the tip of the detachable needle 561. In the reduced diameter portion 561A of the detachable needle 561, the end portion 165A is restored and closed to engage with the detachable needle 561. Since the end 165A of the wire spring 165 in this state is hooked on the wall surface of the member 622 on the distal end side, the wire spring 165 locks the detachable needle 561 even if the detachable needle 561 is pulled. Therefore, the detachable needle 561 does not come off the casing 150. By adopting a structure in which the wire spring 165 is inserted from the distal end side, the distal end side member 621 and the proximal end side member 622 of the casing 150 can be integrated. Therefore, the detachable needle 561 can be reliably accommodated.

  Conventionally, when the casing is composed of two members, they are integrated by adhesion or ultrasonic welding. In this case, if separated at the joint portion, the distal end side of the detachable needle 561 may be exposed to contact the tissue and cause damage. In this embodiment, since the casing 150 is integrated and not separated, the wire spring 165 is inserted and assembled from the opening side of the distal end that receives the detachable needle 561, and assembled, and the wire spring 165 is attached at an undercut portion. It has a structure that prevents it from spreading out.

  When the tissue is bound with the cartridge 153, the pair of forceps members 115 and 131 are closed, and the curved needle 120 is penetrated into the tissue. As shown in FIG. 48, the detachable needle 561 is disposed toward the hand and coaxially with the casing 150. When the hook sheath 21 is advanced on the hand side, the detachable needle 561 is inserted into the casing 150 as shown in FIG. At this time, the pair of arms 392 are pushed by the spacer 601 and the concave portion 202 is tightened, so that the spacer 601 does not drop or the shaft is not displaced. When the detachable needle 561 is locked by the wire spring 165, the hook sheath 21 is pulled back on the hand side. As shown in FIG. 50, the detachable needle 561 is detached from the curved needle 120 and pulled into the tip cover 560 together with the casing 150.

  Thereafter, the pair of forceps members 115 and 131 are opened, and the hook sheath 21 is advanced. As shown in FIG. 50, when the casing 150 protrudes ahead of the tip cover 560, the hook operation unit 14 on the hand side is pulled to retract the hook 581. The suture 125 is pulled to tighten the tissue. After the tissue is tightened, the hook sheath 21 is retracted and the hook 581 is advanced to remove the casing 150 from the support member 591. The hook 581 is protruded from the support member 591, and the suture thread 125 is detached from the hook 581. The cartridge 153 is left in a state where the tissue is tightly bound.

(Third embodiment)
As shown in FIG. 52, the scope holder 26 is provided with a receiving portion 701 attached to the endoscope operation portion 4A. The receiving portion 701 has a substantially C-shaped cross section, and a notch 702 is formed in accordance with the forceps plug portion 4B. When the scope holder 26 is attached to the endoscope 4, the receiving portion 701 is fitted into the endoscope operation portion 4 </ b> A and tightened with a binding band 703 straddling the forceps plug portion 4 </ b> B. The binding band 703 is integrally provided with a locking head portion 705 at one end of an elongated band portion 704. In the band portion 704, a rack is disposed along the length direction. The binding band 703 is locked to each of the two attachment portions 707 and 708 arranged with the notch 702 of the receiving portion 701 interposed therebetween.

  One mounting portion 707 has an insertion portion 707A that allows the band portion 704 to pass but not the locking head portion 705, and is provided with a protrusion 707B that prevents displacement of the band portion 704. As shown in FIG. 53, the other attachment portion 708 is provided with a projection 708A that prevents the band portion 704 from shifting and an insertion portion 708B through which the band portion 704 passes. Further, a locking portion 708C provided with a ratchet claw that engages with the rack of the band portion 704 is fixed to the insertion portion 708B. The ratchet pawl is formed so as not to engage the rack in the direction in which the band portion 704 is inserted, and to engage in the rack in the direction in which the band portion 704 is pulled back. In this scope holder 26, since the forceps plug portion 4B is fastened and fixed by the binding band 703, the scope holder 26 can be attached regardless of the type of the endoscope 4. Further, the suture instrument 1 can be firmly fixed to the endoscope 4 by tightening with the binding band 703.

  A modification of this embodiment will be described. The scope holder 26 shown in FIG. 54 is different in the configuration of the attachment member 710 of the receiving portion 701. The attachment member 710 has a locking portion 708D. The locking portion 708D is cut in a direction orthogonal to the insertion direction of the band portion 704, and the ratchet claw 711 is exposed. When attaching the scope holder 26 to the endoscope 4, the binding band 703 is inserted from the attachment portion 707 and the other end of the band portion 704 is pulled through the attachment portion 708. When removing the scope holder 26 from the endoscope 4, the band portion 704 passed through the locking portion 708D is slid in a direction substantially orthogonal to the insertion direction indicated by the arrow in FIG. 53, and the band portion 704 is cut from the cut surface. Pull out. The binding band 703 can be reused.

  Further, a binding band 712 shown in FIG. 55 may be used. The binding band 712 is formed with a substantially V-shaped cut 713 at the end of the band portion 704. When attaching the scope holder 26 to the endoscope 4, the binding band 712 is inserted from the attachment portion 707. As shown in FIG. 56, the notch 713 of the band portion 704 is hooked on the insertion portion 707A. The other end of the band part 704 is pulled through the attachment member 710. When removing the scope holder 26 from the endoscope 4, the band portion 704 passed through the locking portion 708D is slid and the band portion 704 is pulled out. Since the attachment portion 707 side is simply hooked with the notch 513, the binding band 712 can be easily removed. The binding band 712 can be reused.

  As shown in FIG. 57, a lock portion 715 that can be elastically deformed from the periphery of the notch 702 of the receiving portion 701 may be integrally extended. The lock portion 715 is provided with a claw 715A that is engaged with the forceps plug portion 4B, and a lever 715B that operates to engage and disengage the claw 715A. When attached to the endoscope 4, the lever 715B is pushed to deform the lock portion 715 and open the claw 715A. When the receiving portion 701 is attached to the endoscope 4 in this state, the lever 715B is released. The lock portion 715 is restored, the claw 715A is locked to the forceps plug portion 4B, and the scope holder 26 is fixed. The scope holder 26 can be attached to the endoscope 4 with one touch by lever operation. Note that the lock unit 715 may be configured separately from the receiving unit 701.

(Fourth embodiment)
As shown in FIG. 58, the valve body 721 that bundles the two coil sheaths 41 and 42 and the endoscope insertion portion 5 of the endoscope 4 has a large-diameter through hole as compared with the valve body 50 of the first embodiment. 722. When passing through the endoscope insertion portion 5, the endoscope 4 can be easily inserted by making it difficult to contact the inner peripheral surface of the valve body 721. Further, the diameter of the press-fitting portion 723 of the valve body 721 is made smaller than that of the first embodiment. Even if the press-fitting portion 723 is crushed through the endoscope 4, the contact area with the endoscope 4 becomes small, so that the endoscope 4 can be easily inserted. According to this valve body 721, the operation | work which penetrates the endoscope 4 becomes easy.

Further, in order to reduce the sliding resistance when the valve body 721 is inserted into the overtube 6, the radius of the press-fit portion 724 on the outer periphery of the valve body 721 is reduced. Even if the press-fit portion 724 is crushed in the overtube 6, the contact area can be reduced, so that the insertion becomes easy. Note that the size of these press-fit portions 724 is set to a size that provides a good balance between airtightness and slidability.
Furthermore, in order to reduce the sliding resistance when the valve body 721 is inserted into the overtube 6, the hardness of the rubber constituting the valve body 721 is reduced from, for example, the conventional 50 ° to 40 °. The amount of force required for insertion into the overtube 6 can be reduced, and the treatment time and work stress can be reduced.

(Fifth embodiment)
FIG. 59A and FIG. 60 show a modification of the cartridge. FIG. 61 shows a hook used with this cartridge.
In the cartridge 751, the suture thread 125 is passed through the casing 150, and the detachable needle 561 is attached to the suture thread 125. The suture thread 125 is passed through the brake portion 191 in the hole 190 of the member 621A on the proximal end side, pulled out, folded back outside the casing 150, and drawn back into the member 621A. Loop 125A is formed. An end portion of the suture thread 125 drawn into the casing 150 is caulked and fixed to a brake portion 191 accommodated in the hole 190. Further, the knot 126 is formed to prevent the knot 126 from coming off. The means for fixing the suture thread 125 may be either caulking fixation or the knot 126.
In this cartridge 751, since the loop 125A of the suture thread 125 extends into the member 621A, the suture thread 125 extending from the member 621A is apparently two.

The hook 581A shown in FIG. 61 does not have a so-called overhang shape in which the proximal end of the portion through which the suture thread 125 is passed is protruded toward the distal end. Only the hook 581A moves forward. When the hook 581A is further advanced and abuts against the brake portion 191, the casing 150 can be reliably detached. Note that when binding the tissue, the hook 581A is retracted as shown in FIG. Since the loop 125A of the suture thread 125 is hooked on the hook 581A, the suture thread 125 can be drawn.
When such a hook 581A is used, the casing 150 can be pushed directly, so that the casing 150 can be pushed out reliably.

  In the example shown in FIG. 59 (a), a space 190A capable of accommodating the knot 126 is provided in the axial direction in the hole 190 of the casing 150, but the space 190A on the distal end side may be omitted. In this case, as shown in FIG. 59 (b), the knot 126 is folded back to the hand side and accommodated in the hole 190.

(Sixth embodiment)
FIG. 63 shows a cross section of a treatment portion 807 of a suture instrument 801 (applicator) that is a treatment tool for endoscope. The holding structure of the casing 150 can use the second embodiment.
As shown in FIGS. 63 and 64, the treatment section 807 includes a first link 811 for rotating a forceps member 115 as a first forceps member in a distal end cover 810, and a forceps member as a second forceps member. A second link 812 for rotating 131 is provided.

  The first link 811 is connected to the link member 111 by a pin 821 so that the connecting rod 822 can advance and retreat. The connecting rod 822 extends in parallel with the rod 100 that is an input member, and is supported by the tip cover 810. A proximal end portion of the connecting rod 822 is a first connecting portion 823 through which the connecting rod 822 is inserted. In the first connection portion 823, two control plates 824A and 824B are disposed in the front and rear in the forward / backward direction of the rod 100. These control plates 824A and 824B are inserted one by one into the two slits 825 provided in the first connection portion 823 so as to be tiltable. Each control plate 824A, 824B is formed with one hole 826, and the rod 100 is passed through each hole 826. Further, the coil spring 827 passed through the rod 100 presses between the control plates 824A and 824B, and is inclined so that the slit 825 side is close and the opposite side is separated in a side view. The holes 826 are sized to engage the rod 100 when the control plates 824A and 824B are inclined, and to form a clearance with the rod 100 when the control plates 824A and 824B are set up perpendicular to the axis. The control plate 824A on the distal end side protrudes to the opposite side through the slit 828.

  The second link 812 is connected to the link member 112 by a pin 831 so that the connecting rod 832 can advance and retreat. The connecting rod 832 is supported by the tip cover 810 in parallel with the rod 100 on the opposite side of the rod 100 from the first link 811. The connecting rod 832 forms a second connection portion 833 on the distal end side of the first connection portion 823 of the first link 811. The rod 100 is passed through the second connecting portion 833 so that the rod 100 can advance and retreat, and two control plates 834A and 834B are disposed inside and behind the rod 100 in the advancing and retracting direction. The control plate 834A on the distal end side is inserted in a direction rotated 90 ° around the axis with respect to the control plates 824A and 824B of the first link 811, and is inserted into a slit (not shown) formed in the second connection portion 833. It is passed freely. The control plate 834B is inserted from a direction rotated about 180 ° around the axis with respect to the control plates 824A and 824B, and is tiltably supported by the slit 835 of the second connection portion 833. The rod 100 is passed through the hole 836 of each control plate 834A, 834B, and is urged away from each other by a coil spring 837 passed through the rod 100. The hole 836 is sized to engage the rod 100 with the control plates 834A and 834B tilted, and to form a clearance with the rod 100 when the control plates 834A and 834B are set up perpendicular to the axis. The control plate 834B protrudes to the opposite side through the slit 838.

  A lock arm 841 is disposed substantially parallel to the hook sheath 21 side of the rod 100. The lock arm 841 is supported by the tip cover 810 so that the pin 132 can pass through the elongated hole 842 and can swing. The lock arm 841 includes a protrusion 843 that can be engaged with the second connection portion 833 of the connecting rod 832 from the front end side, and a rack 844 that can be engaged with the control plate 834A. Projecting in a bowl shape toward the rod 100. The lock arm 841 is urged between the elongated hole 842 and the protrusion 843 in the direction toward the rod 100 by a holding spring 845.

  The front end cover 830 is provided with an abutting portion 851 capable of contacting the control plate 834A on the front end side of the second connection portion 833. In addition, at the initial position shown in FIG. 63, an abutting portion 851 is provided on the proximal end side of the control plate 834B so that the control plate 834B can contact a portion protruding from the connecting rod 822. Further, an abutting portion 853 capable of contacting the control plate 824B is provided near the proximal end of the rod 100. Further, a riding-up portion 854 that rides on the lock arm 841 and opens a gap between the control plate 824A and the lock arm 841 is provided.

The operation of the suturing device 801 will be described.
When closing the pair of open forceps members 115 and 131, the rod 100 is retracted. Each of the links 811 and 812 is connected to the rod 100 when the control plates 824B and 834B on the base end side are inclined. Therefore, as shown in FIG. 65, as the rod 100 is pulled, the pair of forceps members 115 and 131 rotate in the closing direction. The lock arm 841 is disengaged from the protrusion 843 and the connecting rod 822 when the connecting rod 822 of the second link 812 is pulled. By urging the holding spring 845, the proximal end side of the lock arm 841 toward the proximal end of the suturing device 801 is rotated toward the rod 100. However, since the direction of the rack 844 of the lock arm 841 is formed so as to escape, the lock arm 841 rotates even when the pressing spring 845 is biased, and is not locked to the control plate 824A moving in this direction.

  As shown in FIG. 66, when the pair of forceps members 115 and 131 are respectively rotated by 90 ° with respect to the initial state, the control plate 834B of the second link 812 contacts the abutting portion 852 of the tip cover 810. The control plate 834 </ b> B is pushed by the abutting portion 852 and is returned to a substantially horizontal position against the coil spring 837. As a result, the connection between the second link 812 and the rod 100 is canceled. As shown in FIG. 67, when the rod 100 is further pulled, the forceps member 131 connected to the rod 100 does not rotate, but only the forceps member 115 rotates.

  As shown in FIG. 68, when the forceps members 115 and 131 are closed, the control plate 824B of the first link 811 comes into contact with the abutting portion 853. The control plate 824B is pushed by the abutting portion 853 and returned to the substantially horizontal state against the coil spring 827. As a result, the connection between the first link 811 and the rod 100 is canceled. This position corresponds to the position where the rod 100 is pulled most. At the same time, the control plate 824A hooks and moves the lock arm 841 in the moving direction when the rod 100 moves backward, so that the lock arm 841 rides on the riding section 854 and the ratchet pawl 844 is moved even if the control plate 824A moves. The state of no interference is maintained.

  When the rod 100 is advanced from a state where the pair of forceps members 115 and 131 are closed, the second link 812 is interlocked with the rod 100 by the engagement of the control plate 834A on the distal end side and the rod 100, and the forceps member 131 is opened. Immediately before the forceps member 131 is fully opened, the lock arm 841 rides on the connecting rod 822 and is pushed toward the tip. At the same time, the first link 811 is interlocked with the rod 100 by engagement of the control plate 824A on the distal end side inclined by the lock arm 841 and the rod 100, so that the forceps member 115 is opened. As shown in FIG. 69, when the forceps member 131 is rotated 90 ° and opened, the control plate 834A comes into contact with the abutting portion 851 on the distal end side and is pushed back substantially vertically against the coil spring 837. Therefore, thereafter, even if the rod 100 is advanced, the forceps member 131 does not move. The forceps member 115 opens over 90 ° to about 180 ° because the first link 811 remains engaged.

  Here, when the rod 100 is pushed back from the position shown in FIG. 67, the forceps members 115 and 131 can be opened sequentially. As shown in FIG. 65, the rack 844 of the lock arm 841 engages with the control plate 824A of the first link 811 to level the control plate 824A. As a result, the connection between the first link 811 and the rod 100 is canceled. Only the forceps member 131 is opened without opening the forceps member 115. As shown in FIG. 71, when the forceps member 131 is opened 90 °, the control plate 834A comes into contact with the abutting portion 851, and the connection between the second link 812 and the rod 100 is released.

  In this embodiment, the two connecting portions 823 and 833 are detachably connected to one rod 100, and a point for intermittently connecting in the forward and backward direction of the rod 100 is provided for each connecting portion 823 and 833. Since the forceps members 115 and 131 are configured to be independently rotatable, the tissue can be regripped or reinserted, and the target tissue can be reliably grasped.

  A variation of the opening / closing operation of the pair of forceps members 115 and 131 will be described with reference to FIGS. In each figure, the horizontal axis represents time, and the vertical axis represents the rotation angle of the forceps members 115 and 131 and the stroke amount of the rod 100 from the open state. Line S1 shows the trajectory of the change in the stroke amount of the rod 100, and the larger the number, the closer to the hand side. Line S2 shows the locus of the rotation angle of the forceps member 115 that changes in accordance with the stroke amount of the rod 100. Line S <b> 3 indicates the locus of the rotation angle of the forceps member 131 that changes in accordance with the stroke amount of the rod 100. The rotation angle indicated by the lines S2 and S3 is 0 ° at the position where the forceps members 115 and 131 are completely opened.

  In FIG. 72, the rod 100 was moved from the most advanced position to the most retracted position as indicated by the line S1, and advanced again. As shown in line S2, the forceps member 115 always moved in conjunction with the rod 100. As shown in line S3, the forceps member 131 did not rotate more than 90 °.

  In FIG. 73, the rod 100 is pulled back from the most advanced position, and the rod 100 is advanced when the pair of forceps members 115 and 131 are closed by 90 °. When the rod 100 is advanced, the forceps member 115 is stopped and the forceps member 131 is opened corresponding to the rod 100. Thereafter, when the rod 100 was pulled, the pair of forceps members 115 and 131 both turned in the closing direction and stopped at 180 ° and 90 °, respectively.

  In FIG. 74, the rod 100 is pulled back from the most advanced position, and the rod 100 is advanced when the forceps member 115 is rotated 135 ° beyond 90 °. The forceps member 131 opened with the movement of the rod 100, but the forceps member 115 stopped. When the rod 100 was pulled back again, the pair of forceps members 115 and 131 were closed.

  In FIG. 75, the rod 100 is pulled back from the most advanced position, and the moving direction of the rod 100 is switched to forward before reaching 90 °. As the rod 100 moves, the forceps member 131 opens, but the forceps member 115 stops. When the rod 100 was retracted again, the pair of forceps members 115 and 131 were closed.

  As an example of such an operation, the operation corresponding to FIG. 73 is specifically shown in FIGS. As shown in FIG. 76, the curved needle 120 attached to one forceps member 115 starts to be inserted into the tissue on one side of the opening. As shown in FIG. 77, one tissue of the wound portion T1 is gripped and gripped by a pair of forceps members 115 and 131, and the curved needle 120 penetrates the tissue. When the rod 100 is moved in the distal direction from this state, the engagement between the link for rotating the forceps member 115 and the rod 100 is released, so that only the forceps member 131 is opened. As shown in FIG. 78, the forceps member 131 opens, but the curved needle 120 remains penetrated through the tissue. The suture instrument 801 is moved, and the forceps member 131 is bitten into the tissue on the opposite side of the wound part T1, as shown in FIG. When the rod 100 is moved in the proximal direction, the forceps member 131 is closed while the forceps member 115 on the curved needle 120 side is stopped. As shown in FIG. 80, the tissue pushed by the forceps member 131 is pierced through the curved needle 120. Further, when the rod 100 is advanced, the forceps member 115 side link is connected and the pair of forceps members 115 and 131 are closed as shown in FIG.

  73 and 75, the forceps member 131 with the smaller pivotable range can be rotated while the forceps member 115 with the larger pivotable range is stopped at 90 °. This is effective when inserting the curved needle 120 again. When the rod 100 is moved so as to open the pair of forceps members 115 and 131 between time 3 and time 5 in FIG. 73 or between time 4 and time 7 in FIG. The forceps member 115 is stopped until the forceps member 131 having a small rotation range is fully opened.

  In FIGS. 73 and 75, the forceps member 131 with the smaller pivotable range can be opened while the forceps member 115 with the larger pivotable range is stopped. Since the forceps member 131 is grasped by the biasing spring 577 and grasps the tissue, when the pair of forceps members 115 and 131 are opened, the forceps member 115 is opened before the forceps member 131 and the bending needle 120 is moved. It may come off. In such a case, the forceps member 131 can be opened with the forceps member 115 inserted into the tissue. As described above, when the pair of forceps members 115 and 131 can be independently operated by the rod 100, after the tissue is once punctured by the forceps member 115, only the forceps member 131 is opened as it is and another tissue is included again. Can be punctured. Also, with such a configuration, it is possible to move the target at the target position.

(Seventh embodiment)
The mounting device 901 shown in FIGS. 82 and 83 has a cartridge 153 accommodated in an interior in which two base plates 902 and 903 are bonded together. The mounting device 901 includes an elongated needle holding portion 911 and a casing holding portion 912, and the needle holding portion 911 and the casing holding portion 912 are connected by an arm portion 913. This attachment device 901 is used by attaching the suturing device 1 from the direction indicated by the arrow in FIG.

  A pair of lock members 921 and 922 are attached to the casing holding portion 912 so as to be freely opened and closed. Projections 921A and 922A are formed at the ends of the lock members 921 and 922, respectively. These protrusions 921A and 922A are inserted into the guide holes 80C of the distal end cover 80 of the suture instrument 1. When the guide hole 80 </ b> C is formed only on one side surface, the protrusions are formed only on the corresponding lock members 921 and 922.

  As shown in FIGS. 84 and 85, in the base plate 903, a plate 931 that forms the needle holding portion 911 is elongated along the insertion direction of the suture instrument 1 indicated by an arrow in the drawing. A receiving portion 932 that can receive the curved needle 120 is recessed at the end. The opening width of the receiving portion 932 gradually increases so that the curved needle 120 can be easily received. A removable needle 561 is accommodated in the back of the receiving portion 932. The receiving part 932 is formed with a notch 932 </ b> A for pulling out the suture 125. In order to elastically support the detachable needle 561, a stay 933 is provided on the plate 931 in a direction orthogonal to the detachable needle 561. Further, the detachable needle 561 is supported by a needle holder 935 mounted on the plate 931. The needle holder 935 is cantilevered by the support portion 935A, can receive the curved needle 120, and supports the detachable needle 561 by centering it.

At the end of the plate 931, a plate 940 forming the arm portion 913 is integrally formed and extends in a direction orthogonal to the plate 931. A plate 941 forming a casing holding portion 912 is integrally connected to the end portion of the plate 940.
The plate 941 is provided with a slide groove 943 along the direction of the arrow. A holder 942 for accommodating the casing 150 is disposed in the slide groove 943. In the middle of the slide groove 943, a locking groove 944 is recessed in a direction substantially orthogonal to the length direction of the slide groove 943. In addition, a guide piece 945 for guiding the suturing device 1 and an arm 946 for elastically pressing the forceps member 131 are integrally extended on the plate 941. A lock member 922 is rotatably supported on a shaft 947 provided substantially at the center. The plate 941 extends substantially parallel to the plate 931, and guide pieces 931A, 931B, and 941A are erected on the adjacent ends of the plates 931 and 941, respectively.

  The base plate 902 includes a plate 948 constituting the needle holding portion 911, a plate 949 constituting the casing holding portion 912, and a plate 950 constituting the arm portion 913. The configuration of the inner surface of the base plate 902 is substantially the same as that of the base plate 903. However, the base plate 902 is not provided with the stay 933. Further, a groove for slidably receiving the guide pieces 931A and 931B is provided in the plate 903, and a groove for slidably receiving the guide piece 941A is formed in the plate 948.

As shown in FIG. 86, in the holder 942, a cylinder 952 is rotatably inserted into a main body 951 that can accommodate the casing 150.
A casing 150 is inserted into the main body 951 of the holder 942. The main body 951 has the casing 150 locked by a pair of elastically deformable arms 953, and a part of the base end of the casing 150 is exposed outside the holder 942. A protrusion 951A is provided in a flange shape on the outer periphery of the main body 951, and a thread holder 955 is attached so as to abut against the protrusion 951A.

  As shown in FIGS. 86 and 87, the thread holder 955 has a substantially C-shaped cross section, and a part thereof is recessed in an arc shape in accordance with the cylinder 952. A groove 956 through which the suture thread 125 passes is formed from the arcuate curved surface 955A to the inner peripheral surface. A guide portion 957 extending substantially along the casing 150 is provided on the opposite side of the curved surface 955A with respect to the central axis. The suture thread 125 is wound around the shoulder portion 957A on the outer periphery of the guide portion 957.

As shown in FIGS. 86 and 88, the suture thread 125 is pulled out of the casing 150 and wound around the outer periphery of the casing 150 in a single layer. The loop 125A is drawn around the shoulder portion 957A of the guide portion 957 of the thread holder 955, and then is wound around the cylinder 952 through the groove 956. A knot 125 </ b> C that is hooked to the cylinder 952 is formed in the middle of the loop 125 </ b> A.
The cylinder 952 has a groove 961 formed toward the center of the cylinder. The groove 961 allows a single suture 125 to be inserted therethrough, but the knot 125C has a width through which it cannot pass. The cylinder 952 is urged so as to rotate about an axis by a torsion coil spring (not shown) accommodated in the main body 951. As shown in FIG. 86, a part of the cylinder 952 protrudes from the end of the main body 951, and the protruding portion 952A is provided with a stopper 962 bulging radially outward. The stopper 962 is inserted into the locking groove 944 on the base plate 902 side.

  The length of the holder 942 is smaller than the length of the slide groove 943 of the base plate 902. A coil spring 965 is bridged between the end on the arm portion 913 side and the holder 942, and the holder 942 is always urged toward the plate 940 side. However, since the stopper 962 is locked in the locking groove 944 in the initial state, the holder 942 is not pulled toward the plate 940 side.

As shown in FIG. 89, when the cartridge 153 is mounted, the hook sheath 21 (the sheath that houses the traction member that pulls the non-treatment side of the indwelling device 20) with the pair of forceps members 115 and 131 opened. ) Is advanced, and the tip claw portion 211 (see FIG. 10) in the casing support portion 86 is protruded to the tip.
90 and 91, when the treatment portion 7 is pressed against the mounting device 901, the protrusions 921A and 922A of the lock members 921 and 922 fit into the guide groove 80C of the distal end cover 80 of the suture instrument 1.

  At this time, in the forceps member 115, the curved needle 120 enters the receiving portion 932 of the needle holding portion 911. Since the receiving portion 932 has a truncated cone shape such that the opening diameter decreases as it goes deeper, even if there is a slight misalignment between the curved needle 120 and the receiving portion 932, the curved needle 120 is Following the taper of the portion 932, it is guided to the detachable needle 561. The curved needle 120 starts to fit into the detachable needle 561 centered by the needle holder 935 while pushing away the needle holder 935. By being pushed away by the curved needle 120, the needle holder 935 moves beyond the stay 933 with the cantilevered portion 935A as a fulcrum, and retracts from the moving path of the curved needle 120. At this time, the tip of the stay 933 is pressed against the needle holder 935 so that the needle holder 935 does not return to the detachable needle 561 side.

  Here, since the detachable needle 561 is supported near the opening end of the receiving portion 932, the curved needle 120 is fitted while pushing the detachable needle 561. The needle holding portion 911 can move freely with respect to the casing holding portion 912 due to the elastic deformation of the arm portion 913, but the guide pieces 931A, 931B, 941A on the base plate 903 side are only along the groove on the base plate 902 side. Since it cannot slide, the movement direction of the needle holding part 911 is restricted only to the insertion direction of the suture instrument 1. Therefore, the bent needle 120 is securely attached without being displaced from the axis of the tip of the curved needle 120 and the axis of the detachable needle 561.

  On the other hand, the forceps member 131 abuts against the arm 946 of the casing holding part 912. The forceps member 131 is biased in the opening direction by the arm 946. As a result, even if there is play or manufacturing error in the forceps member 131, the pair of forceps members 115, 131 are forcibly opened to a state suitable for mounting the cartridge 153.

As shown in FIG. 92, the hook 212 is advanced to push the casing 150 into the holder 942. When the casing 150 is completely pushed in, the loop 125A of the suture thread 125 that has been wound around the outer periphery of the casing 150 is left, so that the cylinder 952 is rotated with respect to the main body 951 by the torsion coil spring. When the loop 125A is wound around the cylinder 952, the suture thread 125 is pulled and wound around the hook 212.
When the hook 212 is pulled back, the suture thread 125 is caught in the groove 961, so that the thread holder 955 is pulled toward the suture instrument 1. The holder 942 has a stopper 962 hooked in the locking groove 944 and is biased to the opposite side by a coil spring 965. For this reason, as shown in FIG. 93, only the thread holder 955 moves. The suture thread 125 is pulled out of the cylinder 952 so as to be pulled by the thread holder 955.

  The cylinder 952 further rotates when the suture thread 125 is released, and the stopper 962 provided on the portion 952A protruding from the main body 951 is released from the locking groove 944. As shown in FIG. 94, the coil spring 965 is shortened and the holder 942 moves along the slide groove 943. Since the hook 212 does not move, tension is applied to the suture thread 125 wound around the hook 212. When the hook 212 is pulled back, the holder 942 is pulled through the suture thread 125 as shown in FIG. The force pulling the hook 212 and the pulling force of the coil spring 965 act on the arm 953 (see FIG. 86) of the holder 942. When the hook 150 is pulled a predetermined length and the casing 150 is pulled into the casing support 86, the holder 942 moves to the suturing device 1 side together with the casing 150. Since a space where the arm 953 can be opened is secured at this position, the arm 953 is detached from the casing 150, and the casing 150 is detached from the holder 942 and accommodated in the casing support portion 86. When the locking members 921 and 922 are opened and the suturing device 1 is retracted and pulled away from the mounting device 901 as shown in FIG. 96, the mounting of the cartridge 153 is completed.

  In this embodiment, the mounting of the cartridge 153 is facilitated by using the mounting device 901. In addition, since the holder 942 is pulled by the bias of the coil spring 965 after the suture thread 125 is wound around the hook 212, the attachment device 901 has a tension applied to the suture thread 125 wound around the hook 212. Can be drawn into the suture instrument 1. For this reason, the suture thread 125 does not come off from the hook 212, and the cartridge 153 can be securely attached. The mounting device 901 can also be used for the suturing device 501.

(Eighth embodiment)
A mounting apparatus 1001 shown in FIG. 97 has a cartridge 153 accommodated in an interior in which two base plates 1002 and 1003 are bonded together. As shown in FIG. 98, a groove 1009 is formed inside the mounting device 1001, and a rod 1010 is accommodated therein so as to be able to advance and retreat in the length direction. A locking member 1071 is fixed to the tip of the rod 1010, and the casing 150 is held by inserting the locking member 1071 into the casing 150. The locking member 1071 is easily removed by using a rubber shaft that allows the casing 150 to be lightly press-fitted. A coil spring 1012 is wound around the outer periphery of the rod 1010. One end of the coil spring 1012 is locked to the end of the groove 1009. The other end of the coil spring 1012 is fixed to the rod 1010. The rod 1010 is locked by a protrusion 1015 at a position where the coil spring 1012 is compressed to a predetermined length. Therefore, the rod 1010 is biased in the direction of the arrow in FIG. 98 by the amount that the coil spring 1012 is compressed. The protrusion 1015 extends from a button 1014 provided integrally with the base plate 1002. The button 1014 can be pressed in a direction perpendicular to the surface of the base plate 1002, and when the button 1014 is pressed, the protrusion 1015 also moves in the same direction.

The base plate 1002 is further provided with a receiving portion 1016. The receiving portion 1016 can hold the detachable needle 561 while centering, and the width of the opening end side is widened so that the curved needle 120 can be received. An arm 1017 protrudes from the end of the base plate 1002 opposite to the receiving portion 1016.
The base plate 1003 has substantially the same configuration as the base plate 1002 except that the base plate 1003 does not have the protrusion 1013 and the button 1014.

  When the casing 150 of the cartridge 153 is fitted to the locking member 1071, the casing 150 is supported by the rod 1010 as shown in FIG. A detachable needle 561 is attached to the receiving portion 1016. The suture thread 125 is drawn through the gap between the base plates 1002 and 1003.

  When attaching the cartridge 153 to the suturing device 1, the loop 125 </ b> A is hooked on the hook 212 and then the button 1014 is pressed. As shown in FIG. 100, the protrusion 1015 is detached from the rod 1010, and the rod 1010 moves in a direction away from the suture instrument 1. At this time, the suture thread 125 is pulled, and tension is applied between the hook 212 and the loop 125A. The loop 125 </ b> A is not detached from the hook 212 by the action of the coil spring 1012. The curved needle 120 enters the receiving portion 1016 and is fitted to the detachable needle 561. Since the forceps member 131 hits against the arm 1017 and is pressed, the pair of forceps members 115 and 131 are completely opened.

When the hook 212 is pulled, the rod 1010 is pulled through the suture thread 125 and the casing 150. As shown in FIG. 101, the coil spring 1012 is compressed, the rod 1010 protrudes, and the casing 150 is drawn into the casing holding portion in the tip cover 80. Thereafter, when the suturing device 1 is pulled away, the engagement between the casing 150 and the locking member 1011 is released, and the cartridge 153 is delivered to the suturing device 1.
At this time, if an elastic member such as a spring is used so that the hook 212 is pulled back naturally, an operation of pulling the finger-engaging ring 17 on the base end side on the operation unit 2 side becomes unnecessary. As shown in FIG. 102, in the operation unit 2, a spring 1022 is disposed on the outer periphery of the reinforcing pipe 1021 that covers the hook operation wire 18, and the hook operation unit 14 is biased in the proximal direction. When the operation unit 2 is configured as described above, the operation becomes easy even when the cartridge 153 is mounted without using the mounting device 1001 shown in the embodiment.

  In this embodiment, the loop 125A is first hooked on the hook 212, and the cartridge 153 can be attached to the suturing device 1 while applying tension by using the force of the coil spring 1012, so that the loop 125A can be securely removed without detaching from the hook 212. Can be installed. Tension can be applied by button operation, so it can be easily operated even when wearing rubber gloves.

  Here, a modification is shown in FIG. In the mounting device 1101, the rod 1010 is disposed so as to freely advance and retract. When the cartridge 153 is mounted, the loop 125A is hooked on the hook 212, and then the hook 212 is pulled back. The tension is applied to the suture thread 125 by the drag resistance of the rod 1010. In such a mounting device 1101, the cartridge 153 can be mounted on the suturing device 1 with a simple configuration.

  Although the preferred embodiments have been described above, the present invention is not limited to the above embodiments. For example, in the embodiment, it is described for a flexible endoscope having an insertion portion having flexibility, but the present invention can be applied to a rigid endoscope in which the insertion portion is rigid. The components of each embodiment can be used in any combination. Further, for joining the above-described components, laser welding, brazing, soldering, adhesion, press-fitting, caulking, and joining by a combination of these joining methods can be used. Moreover, what consists of two parts may be manufactured integrally by press-contacting or molding. Additions, omissions, substitutions, and other exchanges can be made without departing from the spirit of the present invention. The present invention is not limited by the above description, but only by the appended claims.

1,323,501,801 Suture device (endoscopic instrument)
2 Operation part 3 Insertion part 4 Endoscope 7 Treatment part 13 Forceps operation part 14 Hook operation part 15 Forceps operation wire (operation member)
17 Ring (finger part)
20 Indwelling tool 21 Coil sheath 22 Forceps sheath 25 Advance / Retreat operation part (first holder)
26 Scope holder (second holder)
32 1st adjustment member 37 2nd adjustment member 71 Tip holding | maintenance part 75 pin (1st locking member, tip locking member)
77 Release member (forceps release member)
80 Tip cover 86 Casing support part 100 Rod (input part)
102 ball (forceps locking member)
105 Release member (tip release member)
115,131 Forceps member 120 Bending needle 121,561 Detachable needle 125 Suture thread (thread-like member)
125A, 200 loop (hook engaging part)
140 Charging Spring 150 Casing 151, 152 Stopper 170 Release Hole 191 Brake Part 192 Elastic Member 211 Tip Claw Part 212 Hook 301 Tip Claw Part 302 Claw Part 310 Support Member 323 Suture 325 Casing Holding Part 372 Casing Support Part 561 Removable Needle 572 Casing support portion 581 Hook 591 Support member 592 Arm 601 Spacer 625 Space 751 Cartridge 807 Treatment portion 811 First link 812 Second link 823 First connection portion 824A, 824B, 834A, 834B Control plate 832 Connecting rod 833 Second Connection portion 841 Lock arm 901 Mounting device 912 Casing holding portion 935 Needle holder 1001 Mounting device 1010 Rod 1012 Coil spring 1014 Button 11 1 mounting apparatus

Claims (5)

A first sheath and a second sheath, to which a treatment section for performing treatment on the distal end side is connected, and an operation section for operating the treatment section is connected on the proximal end side;
A pair of first through holes are formed in parallel, and the first sheath and the second sheath are inserted into the pair of first through holes, respectively . A first holder for bundling the sheath;
A pair of second through holes are formed in parallel, and the first sheath and the second sheath are inserted into the pair of second through holes, respectively . Bundling a sheath, a second holder provided closer to the tip than the first holder;
A first adjustment member for imparting sliding resistance to the second sheath with respect to the first holder;
A second adjustment member that imparts a sliding resistance larger than that of the first adjustment member to the first sheath with respect to the second holder;
An endoscopic treatment tool including: The endoscope treatment tool according to claim 1,
A first wire for operating the treatment portion is inserted through the first sheath,
A treatment instrument for an endoscope, wherein a second wire for operating the treatment portion is inserted into the second sheath. The endoscope treatment tool according to claim 2,
The first wire is a treatment instrument for an endoscope which is a forceps operation wire for opening and closing at least one of a pair of forceps members provided in the treatment portion with respect to the other. The endoscope treatment tool according to claim 3 ,
The operation unit is
A forceps operation section for opening and closing the forceps member;
A hook operating section for operating a hook for fastening a suture;
An operation main body in which the forceps operation section and the hook operation section are slidably arranged coaxially;
An endoscopic treatment tool including: The endoscope treatment tool according to claim 4,
The hook operation part is arranged on the distal end side in the insertion direction than the forceps operation part,
The hook operation unit has a plurality of finger hooks extending toward the base end side in the insertion direction,
An endoscopic treatment tool in which the forceps operation section can enter between the finger hook sections.

Images